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Paediatric problems of cough
1Paediatric Respirology, Imperial School of Medicine at National Heart and Lung Institute, and Royal Brompton Hospital, London, UK. a.bush@rbh.nthames.nhs.uk
Insights
Diagnosing childhood cough involves categorizing it into five groups, distinguishing serious illnesses from treatable conditions and asthma syndromes. Effective management focuses on underlying causes and environmental factors, not cough syrups.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Diagnosis
Background:
- Childhood cough is common, but identifying its cause requires careful evaluation.
- Most children with cough are otherwise healthy, necessitating a structured diagnostic approach.
Purpose of the Study:
- To outline a diagnostic framework for isolated childhood cough.
- To differentiate between various causes of cough, including serious illnesses, treatable conditions, and asthma syndromes.
- To guide appropriate management strategies based on the cough etiology.
Main Methods:
- Detailed history and physical examination are primary diagnostic tools.
- Targeted investigations are employed selectively based on clinical suspicion.
- Diagnostic criteria for cough variant asthma in different age groups are proposed.
Main Results:
- Children with isolated cough can be classified into five categories: normal, serious illness, non-serious treatable causes, asthma syndrome, or overestimation of symptoms.
- Cough syrups are ineffective; treatment should target the underlying condition.
- Environmental factors like smoking and allergens are crucial considerations.
Conclusions:
- A systematic approach aids in accurate diagnosis and management of childhood cough.
- Avoiding over-diagnosis of asthma in cases of chronic non-specific cough is essential.
- Long-term outcomes for children with chronic non-specific cough are generally favorable without specific treatment.
Abstract:
All children cough, but most children are normal. In a child with isolated cough, a detailed history and examination, followed in a small number of cases by targeted investigations, should allow the child to be placed in one of five diagnostic categories. These are normal child; the child with a serious illness such as cystic fibrosis, tuberculosis etc. the child with non-serious, but treatable causes of cough and wheeze, for example gastro-oesophageal reflux or postnasal drip; the child with an asthma syndrome and an overestimation of symptoms for psychological or other reasons by either or both of child or family. Treatment is of the underlying condition if appropriate. Non-specific treatment with cough syrups are not useful. Attention to environmental factors such as active and passive smoking, and exposure to dust and pets is important. The diagnosis of cough variant asthma should only be made in older children after variable airflow obstruction and response to bronchodilator has been demonstrated physiologically. In younger children, rational diagnostic criteria are an abnormally increased cough, with no evidence of any non-asthma diagnosis, a clear-cut response to a therapeutic trial of asthma medication, usually moderate dose inhaled corticosteroids, and relapse on stopping medications with second response to recommencing them. Some such children go on to develop more typical asthma, with wheeze and bronchial hyper-reactivity. It is important however, not to over-diagnose asthma in children who in fact have a chronic non-specific cough. Such children require no treatment, get better with time, and have normal long-term lung function.