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[Chronic cough in pediatrics: Review and analysis]
1Universidad Veracruzana, Immunología clínica, alergia, rinologia, y pediatria, Instituto Privado de Alergia, Immunología y Vías Respiratorias (INPAIR), Córdoba, Veracruz, Mexico. sacre_1@hotmail.com.
Insights
Chronic cough in children is common, often due to infections. Evaluation with history, exam, and tests is key for persistent coughs, guiding targeted treatment or trials for conditions like asthma or bacterial bronchitis.
Area of Science:
- Pediatric Pulmonology
- Clinical Medicine
- Respiratory Medicine
Background:
- Chronic cough is a frequent pediatric complaint, with most cases stemming from respiratory infections.
- Serious underlying disorders are rarely the cause of pediatric cough.
- Cough persisting beyond eight weeks warrants thorough medical evaluation.
Purpose of the Study:
- To systematically review and analyze existing literature on the diagnosis and management of chronic cough in children.
- To provide an evidence-based approach for evaluating persistent cough in pediatric populations.
- To identify effective diagnostic strategies and treatment modalities for pediatric chronic cough.
Main Methods:
- Comprehensive literature search of PubMed using keywords: cough, chronic cough, chronic cough in children, persistent cough, and gastroesophageal reflux in children.
- Analysis of published articles to synthesize current understanding of pediatric chronic cough.
- Review of diagnostic recommendations including history, physical examination, chest X-ray, and spirometry.
Main Results:
- A structured diagnostic approach, differentiating between 'wet' and 'dry' cough, is effective for nonspecific cases.
- Treatment trials with inhaled corticosteroids for dry cough (suspected asthma) and antibiotics for wet cough (suspected bacterial bronchitis or sinusitis) are recommended.
- Careful monitoring of treatment response is crucial, with discontinuation and re-evaluation if no improvement is observed.
Conclusions:
- Accurate diagnosis of chronic cough in children is achievable through meticulous medical history, physical examination, and targeted investigations.
- A defined diagnostic algorithm can manage the majority of pediatric chronic cough cases.
- Complex or refractory cases necessitate referral to pediatric specialists in Allergy, Clinical Immunology, and Respiratory Diseases.
Objective:
To review and to analyze the existing literature regarding chronic cough in children.
Material And Methods:
We searched published articles in PubMed using the key words: cough, chronic cough, chronic cough in children, persistent cough, gastroesophageal reflux in children.
Results:
Cough in children is common; the majority of cases reflect respiratory infections. Cough is rarely associated to a serious disorder. All children with cough persisting for more than 8 weeks should be evaluated. A careful history, physical examination, chest x-ray, and spirometry (in an able child) are recommended for all children with chronic cough. If a diagnosis is no evident (nonspecific cough), then an approach based on characterizing the cough as "wet" or "dry" is helpful. In each case, specific etiology-based treatment is recommended when possible; otherwise, a therapeutic trial is indicated with inhaled corticosteroids (ICS) for children with dry cough (for possible asthma) and antibiotics for wet cough (for possible protracted bacterial bronchitis [PPB] or sinusitis). The treatment should be reviewed within the specified time frame for normal response. If no effect is obvious, the treatment should be stopped and alternative diagnosis considered. Multiple etiologies may need to be treated concomitantly. Every effort should be made to identify the underlying cause. Data suggests potential harmful effects of medications used for symptomatic relief of acute or chronic cough in children.
Conclusions:
Medical history and physical examination, together with appropriate investigations allow the correct diagnosis of chronic cough. The diagnostic approach is summarized in Figures 1 and 2. Most cases can be managed with this algorithm. For the difficult, complex and rare cases referral to a Pediatric specialist in Allergy, Clinical Immunology and Respiratory Diseases is warranted.
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