Coughing and wheezing
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Understanding Coughing and Wheezing: Causes and Implications
Common Causes of Coughing and Wheezing
Asthma and Its Variants
Asthma is a prevalent cause of coughing and wheezing in both children and adults. It is characterized by symptoms such as cough, wheeze, and dyspnea (shortness of breath). However, not all cases of cough and wheeze are due to asthma. Conditions like cough variant asthma (CVA) present with chronic cough without wheezing, which can evolve into typical asthma with wheezing over time due to increased airway hyperresponsiveness .
Pseudo-Asthma Conditions
Several conditions can mimic asthma symptoms, leading to misdiagnosis. These include pertussis, cystic fibrosis, primary ciliary dyskinesia, and airway abnormalities like tracheomalacia and bronchomalacia. Vocal cord dysfunction and exercise-induced laryngomalacia can also produce respiratory sounds similar to wheezing, often mistaken for asthma.
Acute Bronchitis
Acute bronchitis is another common cause of cough and wheezing, particularly in children. Studies have shown that nocturnal cough and wheezing are predominant symptoms, which can significantly impact the quality of life of both the children and their parents. Objective monitoring of these symptoms can help in evaluating the effectiveness of treatments.
Rhinitis and Its Association with Cough and Wheezing
Rhinitis as a Risk Factor
Rhinitis, an inflammation of the nasal mucous membrane, has been identified as an independent risk factor for recurrent cough and wheezing in children. This association persists even when asthma is not present, indicating that rhinitis can contribute to respiratory symptoms through different pathways.
Impact on Daily Life and School Absenteeism
School Absenteeism
Respiratory symptoms such as cough and wheeze are linked to significant morbidity, including school absenteeism. Studies have shown that children with these symptoms are more likely to miss school, with cough being the most frequently reported symptom among those missing more than five days of school per year.
Side Effects of Inhaled Medications
Beclomethasone Aerosol
Inhaled medications like beclomethasone dipropionate aerosol (BA) can cause side effects such as cough and wheezing in asthma patients. These side effects can interfere with treatment compliance. Pretreatment with bronchodilators has been found to mitigate these adverse effects in some patients, while others may require a short course of oral steroids.
Phenotypes of Childhood Wheeze and Cough
Distinct Phenotypes
Research has identified distinct phenotypes of wheeze and cough in children, such as atopic persistent wheeze and transient viral wheeze. These phenotypes have different clinical presentations and prognoses, emphasizing the need for age-specific assessments when defining these phenotypes.
Conclusion
Coughing and wheezing are symptoms with a wide range of causes, from asthma and its variants to conditions that mimic asthma. Understanding the underlying cause is crucial for effective treatment and management. Objective monitoring and careful assessment can help differentiate between these causes, ensuring appropriate treatment and improving the quality of life for affected individuals.
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