The difficult coughing child: prolonged acute cough in children

Abstract

Cough is one of the most common symptoms that patients bring to the attention of primary care clinicians. Cough can be designated as acute (<3 weeks in duration), prolonged acute cough (3 to 8 weeks in duration) or chronic (> 8 weeks in duration). The use of the term ‘prolonged acute cough’ in a cough guideline allows a period of natural resolution to occur before further investigations are warranted. The common causes are in children with post viral or pertussis like illnesses causing the cough. Persistent bacterial bronchitis typically occurs when an initial dry acute cough due to a viral infection becomes a prolonged wet cough remaining long after the febrile illness has resolved. This cough responds to a completed course of appropriate antibiotics.

Protrahert bakteriell bronkitt hos barn

“…In protracted bacterial bronchitis, the cough continues for four to eight weeks, and often for several months if not treated (1,3,9).…”

“…In most children, cough associated with viral respiratory tract infections will abate gradually and cease within 3 -4 weeks (4, 10), but in a British study, 10 % of children with viral respiratory tract infection still had a cough after 25 days (4). British authors are of the opinion that a duration of eight weeks better distinguishes chronic cough from expected persistent cough after viral infections (2,3,10).…”

“…Relevant investigations will then be a sweat test (cystic fibrosis), nasal nitric oxide measurement (primary ciliary dyskinesia), CT thorax (bronchiectasis) and immunological assessment, initially with measurement of immunoglobulins and vaccine antibody levels (2,21). Bronchoscopy may also be relevant when the above tests have not identified any cause (2).…”

“…It is important to distinguish possible ongoing protracted bacterial bronchitis from persistent cough following a viral infection or several successive viral infections with wet cough (acute bronchitis) (2,3,10,20).…”

“…Chronic cough is defined in reviews and recommendations from the USA and Australia as continual daily coughing for more than four weeks (1,3,6,11). In most children, cough associated with viral respiratory tract infections will abate gradually and cease within 3 -4 weeks (4, 10), but in a British study, 10 % of children with viral respiratory tract infection still had a cough after 25 days (4).…”