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Paediatric Pulmonology and Allergology
2006 April, Vol. IX, No. 1 (3098-3112)
MANAGEMENT OF CHRONIC COUGH IN CHILDREN
Andrew Bush
Professor of Paediatric Respirology, Imperial School of Medicine at National Heart and Lung Institute and Honorary Consultant Paediatric Chest Physician at Royal Brompton Hospital, London, UK
Chronic cough (cough persisting for more than six weeks) may be seen in normal children (usually recurrent acute, or prolonged post-viral); as the first sign of a serious disease; as part of an ‘asthma syndrome’; secondary to a minor specific problem such as reflux or rhinitis, which may occur in isolation, or co-exist with and exacerbate an asthma syndrome; and be nonorganic (habit / honk cough, or parental anxiety). The category is decided by a detailed history and physical examination, occasionally supplemented with targeted investigations. Investigations are warranted if in particular, the cough is wet / productive, and if there are associated extra-pulmonary features, such as digital clubbing, nasal polyps, or rectal prolapse. If a specific diagnosis is made, which is unusual in a community setting where most children with cough do not have an illness, then treatment is directed to the underlying cause. If no cause is found, attention is paid to the environment (passive smoking, indoor and outdoor pollution, allergen exposure), and occasionally a properly conducted therapeutic trial of asthma medications or reflux therapy is warranted.