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Friday, October 14, 2011

recurrent cough and cold, are you worried of asthma or allergy?

ask Child health specialist pediatrician Mumbai....
what is cough, cold and wheeze?
Many parents and people have wierd ideas about cough, cold and wheeze.These interpretation are based on their knowledge, info, myths and perceptions. its better to be clean on these terms when we proceed to discuss further.

Cough: is an explosive sound when air comes out of mouth with a force. noises from nose, chest, throat during breathing is not cough. "Kaff" (in ayurveda) means a lot different than the word "cough". Cough is of different types and varieties, that may help a doctor assess its severity and origin and accordingly plan a therapy.

Cold: Ice is cold, when fever settles hands and feet may go cold. so cold is a very common word used for many issues. When meeting a doctor regarding respiratory issues, we will consider cold as "common cold". The word "common Cold" is used for symptoms of nose and throat with or without fever. Literally its  synonymous with flu.But describing this doesnt help a doctor much to understand the problem. So for all practical purposes we will call cold as runny nose/running nose/stuffy nose/sneezing/watering nose etc. Describing specifically will help doctor plan a specific therapy. cold often may be followed by cough and may be associated with noisy breathing and at times mouth breathing. Read  and understand each word carefully.

Wheezing: its a musical like sound, little longer and high pitch (softer), may be felt by hand on chest or heard aloud at times with child visibly distressed. It is different from noisy breathing which is mainly a sound like snorring or stridor which is louder, and low pitch. Doctor's precision may be needed to separate them. often wheeze is a late sign in asthma , though it has many reasons not related to asthma.

Recurrent cough/ cold/wheeze?
Many parents often feel that their child gets repeated cough cold wheeze etc. Often this may be biased if both parents are working. For example if a child coughs every night and if the parent comes home only at night, while informing the doctor parent may tell he is coughing all the time. This may affect diagnosis and therapy in a great way. Children below 3 year age in India and developing countries, get exposed to a number of respiratory viruses and pollution too. its normal for a child to have 4-8 episodes/year of respiratory issues in infants upto 2 years age. If it is more than 8 per year in first 2 years or more than 3 per year after 2 year age, its likely that this will be called "recurrent".
Recurrent doesnt always mean serious. Serious ones are those that last longer than 7 days, recurr within a gap of 2 weeks and may be life threatening ( see danger symptoms) and may affect weight gain and growth. Serious respiratory symptoms when recurrent (3 per year at any age) may need to be evaluated for associated congenital heart defects.

All these symptoms may be individual or together, with or without fever. Infections often come with fever, allergy / asthma like diseases often come without fever. Occasionally there may be overlap.Allergy / Asthma is difficult to define below 2 years age, its difficult to prove till 6 years age.
Therapy in both groups is primarily symptomatic.Fever medicines for fever, decongestants for runny nose, bronchodilators for wheezers, cough syrups (bronchodilator or suppressive) for cough.
Evaluations / investigations are supportive. Infections may need antibiotics at times, while Allergy / Asthma may need steroids at times.
lets discuss one by one in details. Treatment of runny nose is already discusssed.





 part 2... continued .. please await next posting or put a query in the form on top if you want further details in advance.for free.

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