Chronic cough in children
Dr. Keyvan Maleki Mostashari,Pediatric Pulmonologist
Cough is not an illness by itself, but it is a cardinal manifestation in many chest diseases. It is probably the single most common complaint in children presenting to the physician.In order to treat the patient with cough diagnosis can be as challenging as treatment .
The act of coughing is a reflex aimed at removal of mucus and other material from the airways that follows the stimulation of cough or irritant receptors.
Stimuli that cause coughing may originate centrally, such as in psychogenic cough, or they may be pulmonary, located either in the major airways or in the pulmonary parenchyma. Also, cough can be provoked by nonpulmonary causes , such as irritation of pleura, diaphragm,or pericardium and even through stimulation of Arnold nerve (a branch of the vagus).
Acute cough is defined as lasting less than 3 weeks, while definitions of chronic cough vary from 4 to 8 weeks duration.In assessing chronic cough, the detailed history should be taken , the timing of coughing is important and its relationship to daily routines should be sought. Cough during or after drinking occurs with aspiration . however children with neurologic abnormalities, may take the form of silent aspiration. A cough that occurs after eating solids only may be associated with esophageal pathology such as eosinophilic esophagitis. Coughing after a witnessed choking episode is highly suspicious for a retained foreign body aspiration.
Define the nature of the cough; whether it is dry, hacking, or brassy; and whether it is productive by sound and appearance . In young children , expectoration is unusual, but if observed, the quantity and quality of sputum should be noted. In particular, the physician should inquire about the color and odor of the expectorate and about the presence of blood in the sputum.
A cough with a neonatal onset can be associated with congenital infections, (e.g., chlamydia, especially if it has a staccato nature) , with congenital airway or chest malformations (especially if there is an associated wheeze or stridor), and with recurrent aspiration or diseases such as CF and PCD. In older children chronic productive cough, especially if it is year-round or early in the morning is typical for bronchiectasis and related diseases such as cystic fibrosis (CF) and primary ciliary dyskinesia (PCD).
Nighttime cough may be related to asthma or to postnasal drip .Cough that is honking or loud, brassy and sometimes demonstrative in nature, and that resolves when the child is asleep, can be due to a psychogenic cough.
Environmental factors can play an important role in the cause or exacerbation of a cough. We shall not forget ABPA ,Hypersensity Pneumonitis and Helminth Associated Eosinophilic Lung Disease .
Many children suffer side effects of chemotherapy and radiotherapy for malignant diseases and chronic cough is one of the prevalent problems . Children withTB and NTM pulmonary disease can present with any combination of clinical signs and symptoms, though most patients experience chronic cough and sputum production that do not improve with the antibiotic treatment. Connective tissue disorders like SLE and Sjogren ,immune mediated diseases such as GPA are all in list.
As cough per se is not a disease the best strategy to control it is to deal with the causative pathology .
Chronic Cough – Protracted Bacterial Bronchitis –Asthma –Gastroesophageal Reflux – Allergic Pneumonitis
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