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　　秋冬季节，幼儿园和小学的教室里经常能听到小朋友们的咳嗽声此起彼伏，咳咳咳，超过一个月的慢性咳嗽并不少见。爸爸妈妈们带着医院跑了好几次，各路海淘的咳嗽药水，民间偏方也试了个遍，就是断续咳不停，一筹莫展。看来擒贼先擒王，应该找到原因，标本兼治才是王道！上次在12.3的栏目里小编和宝爸宝妈们一起学习了小儿呼吸学科专家们根据大样本多中心研究的结果所总结出来的咱们中国儿童慢性咳嗽的常见原因，今天我们就来看看怎么来标本兼治这个恼人的慢性咳嗽！想要温故知新上一篇的爸妈请戳这里链接孩子咳咳咳，咳不停怎么回事 ---- 儿童慢性咳嗽知多少

　　让我们先从排名前三位最常见的咳嗽原因开始一一分解。各位爸妈小板凳拿拿好，瓜子茶水备备好，小编要开讲啦！

　　1.咳嗽变异型哮喘

　　⑴ 支气管扩张剂诊断性治疗1-2周，吸入治疗或口服。比如，丙卡特罗，特布他林，沙丁胺醇等；如果咳嗽缓解则有助于诊断；

　　⑵ 诊断明确后，选择按照哮喘规范治疗，疗程至少8周；

　　--吸入糖皮质激素（比如普米克，辅舒酮），或者；

　　--口服白三烯受体拮抗剂（顺尔宁）；或者；

　　--吸入糖皮质激素及口服白三烯受体拮抗剂联合治疗，

　　1.Cough- variant asthma:

　　⑴ A trial of bronchodilator inhaler or oral given for 1 to 2 weeks (Procaterol, Terbutaline or Salbutamol). It is mostly like cough-variant asthma if the child responds well.

　　⑵ When the diagnosis of cough-variant asthma is established, the treatment need to be lasted at least 8 weeks.

　　--- Inhaled corticosteroids (Pulmicort, Flixotide ); or

　　---Oral leukotriene Inhibitors (Singulair); or

　　--- Inhaled corticosteroids and oral leukotriene Inhibitors.

　　2.上气道咳嗽综合征

　　根据引起慢性咳嗽的不同疾病，采用不同的治疗方案

　　⑴ 过敏性鼻炎：可以给予抗组胺药物（比如仙特敏，开瑞坦），鼻喷糖皮质激素（比如内舒拿，辅舒良）治疗，或联用白三烯受体拮抗剂 （顺尔宁）等。

　　⑵ 鼻窦炎：需要使用抗生素治疗至少2周，比如阿莫西林类或阿奇霉素；辅以鼻腔黏膜减充血剂或祛痰药。

　　⑶ 增殖体肥大：根据程度，轻到中度者，一般采用鼻喷糖皮质激素（比如内舒拿，辅舒良）联用白三烯受体拮抗剂 （顺尔宁）观察治疗1-3月，无效可考虑采取手术治疗。

　　2. Upper airway cough syndrome:

　　⑴Allergic rhinitis:  oral antihistamine medicines such as Zyrtec and Clarityne, corticosteroid nasal sprays such as Nasonex and Flixonase, and/or leukotriene Inhibitors singulair can be used.

　　⑵ Sinusitis: an antibiotic is needed for at least 2 weeks to zap the infection, such as Amoxicillin or Azithromycin. Nasal sprays can be used to ease congestion symptoms. Expectorants are applied to thin the mucus.

　　⑶ Adenoid hypertrophy: for mild to moderate ones, use intranasal steroids (Nasonex or Flixonase) and oral leukotriene Inhibitors (singulair) for 1 to 3 months. When medication does not correct the enlargement of the adenoid tissue, surgery is often needed.

　　3.(呼吸道)感染后咳嗽

　　一般来说，感染后咳嗽不需要用药治疗，会自己慢慢好转，但如果症状比较严重，影响孩子的生活学习和睡眠，可以考虑使用白三烯受体拮抗剂（顺尔宁）或吸入糖皮质激素（比如普米克，辅舒酮等）。

　　3. Post-infectious cough:

　　Generally, this condition is self-limiting and does not need treatment. If the cough cause significant impairment to sleep, meals or school, treatment is often need, such as leukotriene Inhibitors (singulair) or Inhaled corticosteroids (Pulmicort, Flixotide ).

　　除了以上3个引起最常见的儿童慢性咳嗽治疗之外，那么其他常见的情况怎么治疗呢？让我们一起来看一看。

　　1. 特定病原体引起的呼吸道感染

　　多种病原微生物如肺炎支原体或衣原体，百日咳杆菌、结核杆菌、呼吸道合胞病毒，腺病毒等引起的呼吸道感染也可导致小儿慢性咳嗽，病程可>25天。可以根据相应的病原微生物使用敏感药物针对性治疗。

　　1.Respiratory infections caused by various species of microbial pathogens can lead to chronic cough in children, including Mycoplasma pneumoniae, chlamydia, Bordetella pertussis, Mycobacterium tuberculosis, Respiratory syncytial virus, and adenovirus. The duration could be more than 25 days. Treatments target choosing sensitive medicine accordingly.

　　2.胃食管反流性咳嗽

　　使用H2受体拮抗剂（比如西米替丁)，胃动力药物 ，或质子泵抑制剂(比如奥美拉唑）。改变体位，采取半卧位或俯卧前倾30度；改变食物性状，少量多餐；避免引起返流的食物,比如高脂肪，油炸，酸性食物（橙汁，番茄），巧克力，薄荷，咖啡，洋葱，大蒜及辛辣食物等，忌饱食。如果治疗8周无效，则需考虑其他原因。

　　2.Gastroesophageal reflux-related cough (GERD)：

　　Helpful therapies in children include H2 antagonists (Cimetidine), prokinetic agents, or proton pump inhibitors. Lifestyle changes are often needed. Elevate the head of the child's bed while she/he sleeps to minimize coughing. For older kids, cut back on foods that typically set off symptoms of GERD, such as fatty or fried foods, citrus fruits, tomatoes, chocolate, peppermint, garlic, onion, and anything spicy. If it is not responsive after 8 weeks treatment, then etiologies for cough need to be reassessed.

　　3.非哮喘性嗜酸粒细胞性支气管炎

　　对支气管扩张剂无效，吸入或口服糖皮质激素有效（比如普米克，辅舒酮，必可酮），治疗后咳嗽很快消失或者明显减轻，每天两次，一般持续用药四周以上。

　　3.Nonasthmatic eosinophilic bronchitis

　　This cough generally does responds to bronchodilators but response to the inhaled corticosteroids (Pulmicort, Flixotide, or Becotide). The treatment is twice a day for more than 4 weeks.

　　4.异物吸入