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4/2016
vol. 2
 
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Rekomendacje postępowania diagnostyczno-terapeutycznego w kaszlu u dzieci dla lekarzy POZ

Zbigniew Doniec, Agnieszka Mastalerz-Migas, Katarzyna Krenke, Henryk Mazurek, Przemysław Bieńkowski

Data publikacji online: 2016/12/19
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Kaszel jest najczęstszym objawem chorób układu oddechowego, a odruch kaszlowy jednym z podstawowych fizjologicznych mechanizmów ułatwiających oczyszczanie dróg oddechowych. Kryterium czasu trwania pozwala wyróżnić kaszel ostry i przewlekły. Ze względu na charakter kaszel dzielimy na suchy i produktywny (mokry). W pracy autorzy przeanalizowali postępowanie diagnostyczne u dzieci z kaszlem ostrym i przewlekłym, uwzględniając odrębności badania podmiotowego i przedmiotowego oraz badań dodatkowych. Określono wskazania do stosowania leków przeciwkaszlowych, wskazując na skuteczność i korzystny profil bezpieczeństwa leków o działaniu obwodowym (lewodropropizyna) oraz problem działań niepożądanych i ryzyka nadużywania leków o działaniu ośrodkowym. W grupie leków mukoaktywnych erdosteina wykazuje korzystny, wielokierunkowy zakres aktywności w leczeniu kaszlu produktywnego. Zwrócono uwagę na ograniczone zastosowanie preparatów pochodzenia roślinnego z uwagi na brak jednoznacznie udowodnionej skuteczności. Autorzy określili również sposób postępowania w przypadku kaszlu w przebiegu ostrej infekcji układu oddechowego u dzieci do 2. roku życia.

Cough is the most common symptom of respiratory tract diseases and the cough reflex is one of the basic physiological mechanisms, facilitating the airway clearance. The criterion for the duration of cough allows to distinguish acute and chronic cough. Based on the nature of cough, it is divided into dry cough and productive (wet) cough. In this paper the authors analyzed the diagnostic procedure in children with acute and chronic cough, taking into account differences in medical history, physical examination and additional tests. Indications the for use of antitussives have been defined, pointing at efficacy and a favorable safety profile of drugs with peripheral mode of action (laevodropropizine), as well as the problem of side effects and the risk of excessive use of centrally acting drugs. In the treatment of productive cough, in the group of expectorants erdosteine shows a beneficial in therapy, multidirectional spectrum of activity. Attention was paid to the limited use of herbal formulations, due to the lack of clear evidence of their efficacy. The authors have also identified a method of treatment in case of cough associated with an acute respiratory infections in children under two years of age.
słowa kluczowe:

kaszel ostry u dzieci, kaszel przewlekły u dzieci, leczenie kaszlu, leki przeciwkaszlowe, leki mukoaktywne, mukolityki

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