Cough and shortness of symptoms and causes
Mar 27, 2018
Cough is a protective reflex mechanism, the purpose of which is to remove mucus, sputum or foreign particles from the respiratory tract.
Cough is not an independent disease, but only a symptom. The reasons for its occurrence may be different. Most often, cough is a manifestation of respiratory diseases such as tracheitis, bronchitis, pneumonia, bronchial asthma, sinusitis, tuberculosis, hereditary and congenital diseases of the respiratory system. Often, the cause of cough are cardiovascular disease, accompanied by the development of heart failure, neurological pathology, foreign body entry into the respiratory tract, infectious diseases, such as whooping cough, sarcoidosis, and some other diseases.
According to its characteristics, the cough can be dry and not accompanied by separation of sputum and wet, wet, flowing with the departure of sputum. In this case, sputum can be serous, mucous, mucopurulent, bloody in nature.
Helping a patient with a cough in the first place should be directed to treating the underlying disease that led to it.
Since the most frequent cause of cough is an acute respiratory viral infection, it is necessary to ventilate the patient's room as often as possible. For the period of rising body temperature, bed rest is prescribed.
Food should be age appropriate and contain enough vitamins and microelements. It is important to drink as much liquid as possible, especially during the febrile period. It can be tea, juices, fruit drinks, compotes, warm mineral water.
Wet cough is characterized by sputum separation, it is not necessary to suppress it, it is necessary to use medications that dilute sputum and improve its separation. These drugs include mucolytic and expectorants:
• Acetylcysteine (ACTS) - for children under 2 years of age, the drug is administered orally after a meal of 50 mg;from 2 to 6 years - 100 mg, from 6 to 14 beds - 200 mg, over 14 years - 400-600 mg per day. The drug can be administered intravenously or intramuscularly to children under 6 years old at the rate of 10 mg / kg 2 times a day, over 14 years - 150 mg once a day. The product is available in the form of bags with 100 and 200 mg microgranules and effervescent tablets of 100, 200, 600 mg, as well as 3 ml ampoules containing 300 mg of the substance;
• carbocysteine (bronkatar, mukodin, mukoprint) - children aged 1 month to 2.5 years are prescribed 50 mg twice a day, 2.5 to 5 years, 100 mg twice a day, children older than 5 yearson 200 250 mg 3 times a day. The drug is available in the form of a syrup for children in 100, 125 and 200 ml vials, 375 mg capsules, 5 g pills, and 750 mg chewing tablets;
• Bromhexine( bromoxin, bronhosan, solvine) is available in the form of tablets of 4 and 8 mg, syrups, drops and solutions for oral administration, as well as ampoules. Children under 2 years are prescribed 2 mg 3 times a day, 2 to 6 years - 4 mg 3 times a day, 6 to 10 years - 6-8 mg 3 times a day, children older than 10 years - 8mg 3 times a day;
• Ambroxol( Ambrobe, Ambrohexal, Ambroxol, Ambrosan, Lazolvan, Halixol) - the preparation is available in the form of tablets of 30 mg, syrup in bottles( 15 mg in 5 ml), ampoules. Children up to 2 years of age, the drug is prescribed 7.5 mg 2 times a day, 2 to 5 years - 7.5 mg 2-3 times a day, 5 to 12 years - 15 mg 2-3 times a day,children over 12 years - 30 mg 2-3 times a day;
• mucobene - the drug is administered orally after a meal to children under 2 years of 100 mg 2 times a day, children 2 to 6 years of 100 mg 3 times a day or 200 mg 2 times a day and over 6 years of 200 mg2-3 times a day. The preparation is issued in the form of effervescent tablets of 100, 200, 600 mg and bags with granules of 100,200, 600 mg;
• fluimucil - for infants up to 2 lenth, the drug is given 100 mg twice a day, for children 2 to 6 years, 100 mg 3 times a day or 200 mg 2 times a day, and over 6 years 200 mg 2-3times a day. The product is available in the form of effervescent tablets, pouches with granules and ampoules;
• Plant cough syrup "Doctor Mom" is prescribed for children from 3 to 5 years for / 2 teaspoons 3 times a day, over 6 years - 1 teaspoon 3 times a day;
• Altai root - 2 tbsp.spoonfuls of althea are brewed with 200 ml of hot water, take the drug on / 4- / glass 3-4 times a day;
• mukaltin - 1 / 2-1-2 tablets 3 times a day;root licorice - is applied at the rate of 1 drop per year of life;
• expectorant herbs in the form of nursing fees.
If the disease occurs with a persistent, nasal, dry, paroxysmal cough that is not accompanied by sputum production, the following antitussive drugs are used:
• sinecode - for children aged 2 months to 1 year, 10 drops 4 times a day, from 1year to 3 years - 15 drops 4 times a day, 3 to 6 years - but 25 drops 4 times a day or 5 ml of syrup 3 times a day, 6 to 12 years - 10 ml 3 times a day,over 12 years - 15 ml 3 times a day or 1 tablet 1-2 times a day;
• glauvent - tablets of 10-40 mg for children over 4 years of age for 1 pills 3 times a day;
• Libexin - 25-50 mg 3-4 times a day;
• broncholitin - used in children older than 3 years in the form of a siro on 5-10 ml 3 times a day;
• Stoptussin - given to children 3-4 times a day. Children weighing less than 7 kg receive 8 drops per reception, 7-12 kg - 9 drops, 12-20 kg - 14 drops, 30-40 kg - 16 drops, 40-50 kg - 25 drops. Before taking the drug, dissolve in water.
Combine antitussives with drugs that dilute sputum, it is impossible, as this will lead to the accumulation of mucus and sputum in the airways.
Shortness of breath is a shortness of breath, accompanied by a feeling of lack of air and manifested by an increase in the frequency of respiratory movements. Clinically shortness of breath is manifested by a feeling of lack of air, a feeling of difficulty making an inspiration or exhalation and discomfort in the chest. Breathing becomes superficial and frequent. Often the frequency of respiratory movements increases 2-3 times or more. In the act of breathing, auxiliary musculature is involved - a pathological increase in the work of the respiratory muscles, which is associated with an obstruction to exhalation or inspiration. With exercise, dyspnea is greatly increased. To determine the degree of dyspnea, it is necessary to count the number of respiratory movements in 1 minute and attacks of suffocation. Normally, the rate of respiratory movements of an adult person per minute is 16-20 respiratory movements, children, depending on age, vary from 20 to 35-40 per minute. Counting of respiratory movements is made by counting the number of movements of the chest or abdominal wall imperceptibly for the patient.
The act of breathing occurs when the receptors of the respiratory muscles, the tracheobronchial tree, pulmonary tissue and blood vessels of the small circulation are irritated. At its core, shortness of breath is a protective reaction of the body, which arose in response to a lack of oxygen and an excess of carbon dioxide.
Accumulation of excess carbon dioxide in the blood leads to the activation of the respiratory center located in the brain. To remove carbon dioxide from the body there is compensatory hyperventilation - the frequency and depth of respiratory movements increase. Thus, the physiologically necessary equilibrium between the concentration of oxygen and carbon dioxide is normalized.
Shortness of breath is the main clinical sign of respiratory failure, i.e.a condition in which the human respiratory system does not provide the proper gas composition of the blood, or in the case that this composition is preserved only because of the excessive work of the entire system of external respiration.
In healthy people, dyspnea may appear with physical activity or with overheating, when the body needs increased oxygen supply, and also with a decrease in the partial pressure of oxygen or an increase in the partial pressure of carbon dioxide in the environment, for example, when climbing to a height.
1. Pathology of the respiratory system. Most often, pulmonary dyspnea develops in patients with pneumonia, bronchial asthma, tuberculosis, pleurisy, pulmonary emphysema, pulmonary artery embolism, as a result of a chest injury.
2. The pathology of the cardiovascular system. Dyspnea appears in the case of heart failure, and if at first it appears only with physical exertion, then in time it also appears at rest. In severe bronchial asthma, advanced sclerotic pulmonary arterial changes and hemodynamic disorders, cardiopulmonary dyspnea develops.
3. The defeat of the central nervous system. As a rule, cerebral dyspnea develops as a result of irritation of the respiratory center when the brain is damaged. This may be neurosis, craniocerebral trauma, neoplasm of the brain, hemorrhage. With shortness of breath caused by neurosis or hysteria, as well as in people pretending to have shortness of breath, breathing takes place effortlessly, and when the patient is distracted, the frequency of respiratory movement normalizes.
4. Disruption of biochemical blood homeostasis. Hematogenous dyspnea often develops during poisoning, renal or hepatic insufficiency, as a result of accumulation in the blood of toxic substances that bind hemoglobin and, consequently, reduce the amount of oxygen in the blood, as well as in anemia, accompanied by a direct decrease in the number of red blood cells and hemoglobin.
Pulmonary dyspnea is of three types: inspiratory, expiratory and mixed.
Inspiratory dyspnoea manifests itself in a labored breathing if breathing mechanics fail. As a rule, occurs when the upper parts of the respiratory tract( larynx, trachea and large bronchi) are affected. Inspiratory dyspnoea is accompanied by increased work of the respiratory muscles, which is aimed at overcoming excessive resistance to the inhaled air with the rigidity of the lung tissue or chest. It occurs at a pressure of a tumor, foreign body, reflex spasm of the glottis or inflammation of the mucous membrane of the upper respiratory tract, fibrosing alveolitis, sarcoidosis, valve pneumothorax, pleurisy, hydrothorax, diaphragm paralysis, stenosis of the larynx.
The clinical manifestations of inspiratory dyspnoea are the prolongation of inspiration time, the increase in the frequency of respiratory movements. Inspiratory dyspnea is often characterized by stridorous respiration, which is clinically manifested by inhalation audible at a distance, by the tension of the respiratory muscles and by the entrainment of the intercostal spaces.
Expiratory dyspnea is characterized by the appearance of a labored exhalation, in connection with which the elongation of the expiration time is recorded. It arises as a result of increased resistance to movement of air along the lower parts of the respiratory tract( middle and small bronchi, alveoli).Infringement of a current of air occurs at narrowing of a lumen of small bronchuses and bronchioles as a result of change of their walls and deformation of small and average bronchuses, for example at a pneumosclerosis, an inflammatory or allergic edema, a spasm of respiratory ways( bronchospasm), and also blockage of their lumen by a sputum or a foreign body. To pass air into the lungs there is an increase in intrathoracic pressure, caused by the active work of the respiratory muscles. The change in intrathoracic pressure is manifested by swelling of the cervical veins, pulling of the jugular fossa, supraclavicular and subclavian pits, intercostal spaces and epigastric region on inspiration. In the act of breathing, auxiliary musculature is involved. Often, shortness of breath is accompanied by pain in the chest. Pallor and even cyanosis of the nasolabial triangle, humidity and even marbling of the skin are noted. In severe respiratory failure, the skin is pale, with a grayish hue. The difficulty of exhalation results in the accumulation of air in the lungs, which is clinically manifested by boxed sound with percussion of the chest, lowering of the lower border of the lungs, and also by a decrease in their mobility. Often there is noisy breathing, respiratory crepitation, audible from a distance.
Patients with severe bronchial asthma during exacerbation take a forced sitting position - to facilitate breathing.
In obstructive lung diseases, along with the appearance of dyspnea, there is a cough that is characterized by the release of mucous or mucopurulent sputum.
Expiratory breathlessness is a manifestation of such diseases as bronchial asthma and chronic obstructive bronchitis.
Mixed shortness of breath appears difficulty in both inspiration and exhalation. It occurs in pathological conditions, accompanied by a decrease in the respiratory surface of the lungs, resulting from atelectasis or compression of the pulmonary tissue by effusion( hemothorax, piothorax, pneumothorax).
Cardiac dyspnea is the most frequent symptom of acute and chronic left ventricular or left atrial heart failure, which can develop in patients with congenital and acquired heart defects, cardiosclerosis, myocardial dystrophy, cardiomyopathy, myocardial infarction, myocarditis. Breathing with cardiovascular pathology becomes not only frequent, but also deep, i.e.there is polypnoea. Cardiac dyspnea is worse in the prone position, as the venous return of blood to the heart increases, with physical exertion, neuropsychic overstrain and other conditions, accompanied by an increase in the volume of circulating blood.
A patient with cardiac dyspnea takes a forced position - orthopnea - sitting, resting his hands on the hips, or standing up. Improvement of well-being is associated with a decrease in the fullness of the lungs. A typical sign of heart failure is the appearance of acrocyanosis. Cyanosis of the skin and visible mucous membranes, cooling of the limbs. With auscultation of the lungs in patients with cardiac dyspnea, a large number of scattered moist small bubbles rises.
To clarify the nature of dyspnea, it is necessary to perform chest X-ray examination, electrocardiography, echocardiography, determine the gas composition of the blood( oxygen and carbon dioxide indicators), and investigate the function of external respiration( peakflowmetry and spirography).
Treatment of dyspnea should be aimed at eliminating the disease that led to its occurrence, as well as improving the overall well-being of the patient.
If a patient develops a shortness of breath, he should be seated in an armchair or give him an elevated position on the bed using pillows. It is important to calm the patient, since stress leads to an increase in heart rate and the need for tissues and cells in oxygen. It is necessary to ensure access of fresh air to the room where the patient is located, in connection with which it is necessary to open the window, window or door. In addition to a sufficient amount of oxygen in the air, it is necessary that it has sufficient humidity, which includes a kettle, pour water into the tub, and hang wet sheets. A good effect is provided by inhalation with moistened oxygen.
The process of breathing should be eased to a person with shortness of breath, by freeing him from shy clothes: tie, tight belts, etc.