Fifteen-minute consultation: A structured approach to the management of chronic cough in a child

Abstract

Coughing is a primary pulmonary defence mechanism that enhances clearance of secretions and particles from the airways and protects against aspiration of foreign materials. Coughing may affect 30% of children at any given time (1). Many are healthy children but some may have serious underlying disease. Childhood cough accounts for a large number of consultations and 80% of families who are referred to a paediatric respiratory clinic for chronic cough have sought medical advice five times or more (2). The majority of childhood coughs are secondary to an acute respiratory tract infection and will improve once the infection resolves, usually within 1 to 3 weeks. With pre-school children who may experience between 6 and 10 respiratory infections a year differentiating acute recurrent cough from chronic cough is key (Table 1). Chronic cough can significantly impact a family's quality of life, as it affects the child's sleep, school attendance and play. Parents experience distress and anxiety, worrying that the cough may lead to long-term chest damage or even death (3). This article aims to guide clinicians through the assessment of the child with a chronic cough. It will discuss identifying causes, use of first line investigations, initiating appropriate management and addressing parental anxiety and exacerbating factors (4,5).

Childhood chronic cough made easy: a simplified approach for the primary care setting

“…If this is not the case, modern technology can be of help as parents may be asked to record their child's cough at home using smartphones or other electronic devices. 19,20 In any case, it is important to recognize the child with a chronic wet cough in due time, since this type of cough is usually associated with important underlying disorders. 21 Apart from being dry or wet, disease-specific characteristics can also be discerned; a paroxysmal cough with a classic inspiratory "whoop" points to the diagnosis of pertussis, a barking or brassy cough might be heard in tracheomalacia, whereas the occasional honking cough might fall within the "tic cough" frame.…”

“…21 Apart from being dry or wet, disease-specific characteristics can also be discerned; a paroxysmal cough with a classic inspiratory "whoop" points to the diagnosis of pertussis, a barking or brassy cough might be heard in tracheomalacia, whereas the occasional honking cough might fall within the "tic cough" frame. [19][20][21] Teammates: accompanying symptoms Chronic cough may be presenting as a sole symptom or as part of a clinical spectrum, which can be easily determined by asking the following "6 S" questions:…”

“…Children with hypotonia due to neuromuscular disorders, those with tracheostomy and some with chest wall deformities may report frequent lower respiratory tract infections or, at their very best, a chronic and unremitting wet cough. 20 The clinician should never forget to inspect the fingers. Clubbing is an ominous sign, closely related to serious lung disorders such as CF, PCD, and bronchiectasis.…”

Half of children with recurrent or chronic wet cough before three years of age were symptom‐free by age seven

“…Studies have suggested that protracted bacterial bronchitis (PBB) with bacterial colonisation in lower airways is the most common reason for chronic wet cough in young children, with antibiotics for two to four weeks as the recommended treatment 4,16,17 . However, studies of children with chronic wet cough are largely based on selected patients recruited from tertiary centres 4 .…”

“…16 Studies have suggested that protracted bacterial bronchitis (PBB) with bacterial colonisation in lower airways is the most common reason for chronic wet cough in young children, with antibiotics for two to four weeks as the recommended treatment. 4,16,17 However, studies of children with chronic wet cough are largely based on selected patients recruited from tertiary centres. 4 To date, few studies have evaluated the natural course and identified risk factors for a prolonged course or an underlying chronic disease in children with recurrent episodic or chronic wet cough, including PBB.…”