1. Chronic cough Ágnes Németh 2nd Department of Pediatrics of Semmelweis University

2. Cough Important protective procedure for the cleaning mechanism of the airways from secrets, foreign body etc. Important role in the elimination of bacterias, other infective particles It can prevent severe arrhythmyas This is the most frequent complain for the patients at doctor visits, and the patient pay a lot for madication

3. Case report G. Sz.. born.:28.06.1995 (II/II, 4000 gr) History: from one year of age repetitive wheeze problems, bronchitis Th: continous ICS, beta agonist as he need

4. 10. December. 1999. Fever, UTI Amoxicillin therapy- improved Continous dry cough 17. January 2000. Increasing cough, first dry then mostly wet, then fever appeared. Chest X-ray right upper lobe pneumonia Th: Dalacin

5. 19. January 2000. Admission: 2nd Pediatric Department of SU Status: he is alert, well without fever Above the chest normal knocking sounds, with auscultation puerilic breathing, 1-2 wheeze sounds, 1-1 whistling sound BR: 30/min Laboratory tests: We: 3 mm/h, Hgb:135 mmol/l, Fvs:7,8 G/l

6. Chest X-ray: atelectasy on right upper lobe

7. Bronchoscopy Intacr tracheal system. On the wall of the trachea soluble, purulent mucus. At the orificium of the right upper lobe some white mass can be seen. With sucking an approx. 4 cm long, flexible mucus can be removed. On the blanket it seems a bronchial replica. On left side some purulent mucus.

8. Bronchoscopy 25.01.2000. KÉP

9. Bronchus bact: no bacteria Histology: Fibrin, and inflammatory cells can be found which is bronchial tree replica. Diagnosis: wheeze bronchitis, bronchitis fibrinosa plastica atelectasia

10. Mellkas rtg 2000. 01.26.

11. Chronic cough Cronic cough : Cough last more then 3 weeks Usually more then one problem/ agent can take part in the provocation or keep chronic cough, but sometimes can be the only symptomes of a disease.

12. Couse of chronic cough I. Asthma, wheeze bronchitis PostNasal Drip Syndrome (PNDS), UTI Gastro-esophagealis reflux

13. Chronic cough II. Chronic bronchitis, tracheitis Special infections Mycoplasma pn., Chlamydia, B. pertussis, M.tbc Disease which causes purulent pulmonary disease cystic fibrosis, immundeficienciy, bronchiectasy primer ciliáris dyskinesis Disseminated pulmonary diseases

14. Chronic cough III. Congenital malformation vascular ring, tracheo-bronchomalcia, fistula bronchogen cyst, secvestration, thymus hyperplasy Cardiac disease acyanotic congenital heart disease, VSD, PDA, PS, PH, Fallot IV. Foreign body, tumor, lymphnodes Aspiration central nervous system, neuromuscular diseases Enviromental factors smoking, allergens, chemical irritation, dry home Psychogen os neurotic cough Reflex cough

15. Allgorrhythm of the diagnosis of chronic cough Chronic cough Chest X ray Normal Damaged Bronchoscopy, CT Cytológy, Cardiológy Check the 3 more frequent conditions 1.PNDS 2.ASTHMA 3. GORB ANAMNESIS PHYSICAL EXAMINATION Therapy fit for the diagnosis Cough stoppedContinous cough

16. Allgorrhythm of the diagnosis of chronic cough II. PNDS, ASTHMA, GORB can not be confirmed Postinfection cough Check rare diseases (CF,tbc,allergy, immun status) Bronchoscopy, CT,histology, cytológy, sputum check up Cough stoppedContinous cough To think about that was the therapy correct before the diagnosis of habitual, pszichogen cough