Cough in children: definitions and clinical evaluation

Abstract

The aetiology and management approach for cough in children differs greatly to that in adults, so the empirical approach commonly used in adults is unsuitable for children. Clinical evaluation of cough in children should include an assessment of environmental factors, particularly tobacco smoke, parental concerns and expectations. Most children with acute cough are likely to have an uncomplicated viral acute respiratory tract infection, but the possibility of a more serious problem, especially aspiration of foreign material, should always be considered. Isolated chronic cough in children is rarely asthma, and the term “cough variant asthma” should not be used. Over‐the‐counter and prescription medications are ineffective for the symptomatic relief of acute cough. Treatment for chronic cough should be based on aetiology. Because of the favourable natural history of cough, a “positive” response in medication trials should not be assumed to be due to the medication. Children should be reassessed within the expected timeframe of response to therapy.

Does failed chronic wet cough response to antibiotics predict bronchiectasis?

“…The importance of an early diagnosis and commencement of appropriate treatment for bronchiectasis has long been recognized25 26 and can result in improved short and medium term clinical outcomes,14 27 including complete resolution of bronchiectasis in some children 28. Although guidelines suggest further investigations for children with a chronic wet cough not responding to treatment,2 16 there are no data on when such investigations should begin and what constitutes an adequate trial of antibiotic therapy 7. Our data suggest that children should be evaluated if the cough does not respond to 4 weeks of antibiotics.…”

“…The recommendation that children with a chronic (>4 weeks) wet cough should undergo a careful clinical review2 7 is based upon several key points. First, bronchoalveolar lavage studies in children with chronic wet cough have found evidence of lower airway bacterial infection and inflammation, which in children with PBB will respond to a course of antibiotics 8–12.…”

Validation of a parent-proxy quality of life questionnaire for paediatric chronic cough (PC-QOL)

“…It is thus not surprising that cough is a commonly used outcome measure in research and clinical studies 3–5. Chronic cough is related to a variety of aetiologies6 and may not be categorised into a specific disease process rendering quality of life (QOL) measures for respiratory diseases such as that for asthma unsuitable substitutes for cough research. Disease-specific QOL inventories have been shown to be significantly superior to generic QOL inventories,7 with cough-specific QOL measures for adults8 9 showing specificity and sensitivity over generic QOL measures.…”

Amoxycillin-clavulanate for chronic wet cough in children: cautious interpretation of study findings warranted

“…First, the definition of chronic cough used in the study (greater than 3 weeks) contradicts the authors’ previously recommended definition of 4 weeks 2. Second, for their primary outcome, the authors used improvement in ‘baseline cough score’ based on ‘validated cough diary using the verbal category descriptive (VCD) score’.…”