Q&A on Cough and Difficult Cough

Summary

In this medical transcript, a discussion on pediatric respiratory health focuses on the appropriate use of cough medications and the management of children's coughs. The dialogue emphasizes the importance of identifying the cause of coughs before treatment, the cautious use of mucolytics in young children, and the protective role of coughing. It also touches on the use of nebulized medications, the application of mechanical insufflation-exsufflation (MIE) devices, and the treatment of chronic coughs, advocating for a patient-specific approach and the avoidance of unnecessary medication.

Takeaways

• 👨‍⚕️ Doctor ISO emphasizes the importance of identifying the cause of a child's cough before administering any medication.
• 💊 Mucolytics, such as eucalytic, can be used to thin mucus but should be used cautiously in children under 2 years due to their inability to handle secretions properly.
• 🚫 Doctor ISO advises against suppressing a cough as it is a protective reflex and should be treated with caution, especially with antitussives.
• 🌿 For persistent coughs, especially in children with asthma, bronchodilators may be considered, but they are not beneficial for non-asthmatic patients.
• 🧪 The use of nebulized medications like hypertonic saline (3% NaCl) and NSS (Normal Saline Solution) is discussed, with a focus on proper dosage and frequency for different age groups.
• 🛑 Caution is advised when using nebulized medications, especially in young children, to avoid complications like secretions causing aspiration or airway obstruction.
• 💰 The cost of MIT (Mucus Clearance Therapy) devices is mentioned, with a range of approximately 120,000 pesos, and their effectiveness in treating patients with neuromuscular disorders.
• 🔄 The importance of proper technique and settings when using MIT devices is highlighted, including the initial settings for inspiratory and expiratory pressures.
• 🍼 For children with dry coughs, especially those associated with upper airway cough syndrome, oral antihistamines may be recommended over other cough preparations.
• 🌱 The script discusses the use of over-the-counter medications and the need for judicious use, similar to antibiotics, to avoid unnecessary side effects.
• 🏥 The role of supportive treatment and management for acute coughs in children is emphasized, including increasing fluid intake and monitoring the progression of the cough.

Q & A

What is the general approach to treating cough in children according to the transcript?

The general approach involves identifying the cause of the cough before administering any medication. It's important not to suppress the cough reflex as it is protective. For very young children, caution is advised with the use of mucolytics due to their inability to handle increased secretions.

Why is it crucial to identify the cause of a cough before prescribing medication?

Identifying the cause allows for targeted treatment, ensuring the cough is addressed effectively and safely. Suppressing the cough without addressing its cause may lead to complications, especially in young children.

What are the concerns with using mucolytics in very young children?

Mucolytics thin out mucus, and in very young children, there is a risk they may not be able to handle the increased secretions, potentially leading to aspiration or airway obstruction.

What is the role of cough and cold preparations in treating coughs?

The speaker mentions there is no evidence for the effectiveness of cough and cold medications, especially in children. It is more important to address the underlying cause of the cough rather than just treating the symptoms.

What is the significance of a cough being a protective reflex and why should it not be suppressed?

A cough is a protective reflex that helps clear irritants from the airways. Suppressing it may prevent the body from effectively clearing these irritants, potentially leading to more serious respiratory issues.

What are the considerations when using bronchodilators for children with cough?

Bronchodilators are generally recommended for asthmatic patients, not for all children with cough. They should be used cautiously and only when there is a clear indication, such as asthma, to avoid unnecessary medication.

What is the recommended approach for treating a dry cough in children?

For dry coughs associated with upper airway cough syndrome or allergic rhinitis, oral antihistamines may be given. However, for psychogenic cough, no treatment is recommended as it does not alleviate the cough.

What is the youngest age a MIT (Mechanical In-Exsufflator) device has been used according to the speaker's experience?

The speaker mentions using a MIT device in a patient as young as 3 months old, with the patient now doing well at 9 years old.

What are the initial settings recommended for the inspiratory and expiratory pressures in a MIT device?

The initial settings recommended are around -10 to -15 cm water for both inspiratory and expiratory pressures, adjusted based on the patient's tolerance.

What is the role of epinephrine when added to NSS for mobilization post-excavation?

Epinephrine is mixed with NSS and used post-excavation to help with the medical management for a period of 24 hours at intervals of every six hours, aiding in the treatment process.

What are the key safety considerations for using a mechanical ventilator or MIT device in patients with neuromuscular disorders?

Key safety considerations include checking the initial settings, ensuring patient tolerance, verifying the device's functionality, monitoring cough flow, and combining treatments like chest physiotherapy and suctioning for effectiveness.

How long can oral antihistamines be given to pediatric patients with allergic rhinitis according to the guidelines?

Oral antihistamines can be given for up to 2 weeks, after which a review is necessary. However, in certain cases, they may be used for a month, depending on the patient's condition and environment.