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длительный кашель у детей(нередко " неудобные" и проблемные пациенты на приеме у педиатров).
сокращенный перевод здесь https://forums.rusmedserv.com/showth...68437&posted=1
важные нек.моменты;
Cough is one of the most common symptoms that patients bring to the attention of primary care clinicians. Cough can be designated as acute (<3 weeks in duration), prolonged acute cough (3 to 8 weeks in duration) or chronic (> 8 weeks in duration). The common causes are in children with post viral or pertussis like illnesses causing the cough. Persistent bacterial bronchitis typically occurs when an initial dry acute cough due to a viral infection becomes a prolonged wet cough remaining long after the febrile illness has resolved. This cough responds to a completed course of appropriate antibiotics.
...Prospective studies of acute cough in young children in general practice have suggested that about 50% recover by 10 days and 90% by 3 weeks, so 10% of children still have problems in the third to fourth weeks.

Aetiology of prolonged acute cough

The most common cause for prolonged acute cough in children is post viral or post-infectious cough. Post-infectious cough can be defined as a cough that began with symptoms related to the common cold and persists. It has a high rate of spontaneous resolution without any therapeutic intervention.
Some specific causes of prolonged acute coughing are as follows:

Infants with acute bronchiolitis
...Systematic reviews looking at the therapeutics strategies in reducing the morbidities following acute bronchiolitis showed that neither the use of inhaled glucocorticoids or leukotriene antagonists during acute bronchiolitis prevent post-bronchiolitic wheezing or cough
Pertussis infection

While infants too young to have been vaccinated are at particular risk for severe whooping cough disease there has been a recent epidemic of pertussis as a cause of prolonged acute coughing in older children and adolescents in many countries
In a community study that recruited children (5–16 years of age) coughing for longer than 2 weeks, 37% of them had serological evidence of a recent pertussis infection and the median duration of coughing was 112 days (range: 38 to 191 days)Those children who were negative to pertussis (many with mycoplasma infection) also had prolonged coughing but this was shorter than the pertussis group (median duration 58 days, range 24 to 192 days). Virtually all children in this study had complete resolution of the cough .). It is thus important to note that if a trial of treatment such as inhaled corticosteroids (ICS) had been started the ICS would have appeared to have worked but the resolution would have been due to the natural resolution that occurs.
Treatment with a macrolide antibiotic may be beneficial in pertussis but only when administered in the early stages of the disease. This is difficult to implement because the diagnosis is often not thought about until the cough has become chronic unless there is known contact with an index case. It is recommended to only treat patients aged above 1 year within 3 weeks of cough onset and infants aged less than 1 year within 6 weeks of cough onset [22]. Antibiotics decrease the duration of infectiousness and thus prevent spread [23]. If the patient is diagnosed late, antibiotics will not alter the course of the illness and, even without antibiotics, the patient should no longer be spreading pertussis
Children recovering from a complicated acute pneumonia (e.g. empyema)

At least a third of children who initially have a treated empyema are still coughing by 4 weeks with one quarter at 6 months reducing to around 3% at 12 months. Some of these patients have prolonged cough due to residual of disease and as a result will benefit from a prolonged course of antibiotics 1–4 weeks from discharge or longer
Rhinosinusitis

The criteria used to diagnose rhinosinusitis in children are nasal secretions with or without a wet or dry cough occurring longer than 10 days. Chronic rhinosinusitis is more common in those with atopy and is considered present if symptoms persist longer than 4–8 weeks. Facial pain and discomfort is not so common in children when compared with adults.

Antibiotics are generally recommended for acute bacterial sinusitis but two of the four placebo controlled clinical trials were negative. This may have resulted from including those with allergic rather than an infective cause or an inappropriate antibiotic dosage. In the other two studies using amoxicillin-clavulanate showed considerable benefit although at the cost of increased side-effects
Retained inhaled foreign body

Foreign body aspiration (FBA) is most commonly seen in children below 24 months [28]. The diagnosis should be suspected if there is a history of choking followed by prolonged cough and non-resolving pneumonia. The yield from physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. The sensitivity and specificity for each diagnostic criterion are as follows: clinical history (63% and 32%), symptoms (68% and 53%), physical examination findings (70.5% and 63%), radiological findings (73% and 68%) and the triad of cough, wheeze and diminished breath sound (88% and 51%) respectively [29]. Delayed diagnosis may be related to an unobserved aspiration event or lack of physician awareness and has serious consequences such as chronic cough, recurrent pneumonias and eventually localised areas of bronchiectasis. The immediate management is endoscopic removal of the foreign body and this should be done in case where there is parental or clinical suspicion.
Persistent bacterial bronchitis (PBB) has been defined as the presence of a chronic wet cough with resolution of cough with appropriate antibiotics and absence of pointers suggestive of alternative specific cough [30,31] Recently, an association between PBB starting in infancy and airway malacia (tracheal, bronchial) has been described [32]. The cough of PBB resolves after a course of antibiotic such as amoxicillin-clavulanate for 2 weeks but some require a longer 4–6 weeks antibiotic. If PBB fails to respond to antibiotics or if PBB becomes recurrent, then further investigations are required to rule out the other conditions such as subtle immunodeficiencies or other causes of chronic suppurative lung ...