Summary
Introduction. The tiring, persistent cough of a child is one of the most common reasons for visiting a primary health care physician. It is usually a symptom of an upper respiratory tract infection, so it is not a serious illness. However, the doctor, without examining the child, cannot guarantee that the cough is only associated with a banal infection. We know that it accompanies many diseases, but the lack of studies assessing the extent to which acute coughing in a child with a cold disease indicates infection in the lower respiratory tract.
Aim. The aim of the study was to establish the causes of acute awakening and/or tiring cough in children suffering from upper respiratory tract infection.
Material and methods. A retrospective analysis of data from the medical history of children examined due to cough interrupting sleeping and/or tiring cough upon awakening. 112 children up to six years of age (median age 2.8 years) with an upper respiratory tract infection were included in the study. Based on information obtained from parents, it was determined whether the family had SARS-CoV-2 virus infection in the 10 days before or after the test. The group of children with the acute nonobstructive bronchitis was analyzed in an additional analysis. In these patients, the number of days with coughing before diagnosis and the nature of percussion and auscultation changes were assessed.
Results. The patients were diagnosed with: a) acute nonobstructive bronchitis – 97 children, b) acute obstructive bronchitis – 4 children with dyspnoea, c) laryngitis, tracheitis and croup syndrome – 9 children. Gastroesophageal reflux was suspected in 2 children. In patients with acute bronchitis, the cough lasted from 1 to 21 days (average 2.4 ± 0.9) before diagnosis. Dull percussion was associated with a softened vesicular murmur. These acoustic abnormalities was found in 95 (98%) patients above the right lung and 12 patients above the left. In two cases, a percussion dullness and a softened vesicular murmur were heard only on the left side. Dry rules was heard in 15 children above the right lung and in 10 above the left lung. In two cases, the dry rules were only on the left side, with no similar changes on the right side. In total, typical dry rules over the right and/or left lung were diagnosed in 17 (16%) patients. In the group with dry rules, percussion dullness sound and a softened vesicular murmur were present in 15 children. Dull percussion noise and a softened vesicular murmur without dry rules (silent bronchitis) were heard in 78 (80%) patients. In one case, there was contact with a family infected with the SARS-CoV-2 virus.
Conclusions. 1. Bronchitis is common in children with upper respiratory tract infection coexisting with cough after falling asleep or cough immediately after awakening. 2. Very often, the only auscultatory symptoms in children with bronchitis are a dull percussion sound with a softened vesicular murmur over the right lung. 3. Further studies on a larger population group are advisable.