Causes of chronic cough in children
- Roni Grad, MD
Roni Grad, MD
- Associate Professor of Clinical Pediatrics
- University of Arizona College of Medicine
Chronic cough is typically defined as a cough lasting more than four weeks. This is because most acute respiratory infections in children resolve within this interval. Other schemes define chronic cough as one that last more than eight weeks but also recognize that a relentlessly progressive cough often warrants evaluation prior to eight weeks.
The evaluation of a child with chronic cough should include a detailed history, physical examination, chest radiograph, and spirometry (if the child is able). If the initial evaluation provides clues suggesting a specific cause of cough (ie, caused by an underlying disease), further evaluation is focused on that diagnostic possibility (algorithm 1). The steps are detailed in a separate topic review. (See "Approach to chronic cough in children".)
The causes of chronic cough in children are quite different from that of adults, so evaluation and management of children should not be based on adult protocols. The most clinically important causes of cough in children and the initial steps in management are reviewed here. Adolescents 15 years and older may be evaluated using guidelines for adults . (See "Evaluation of subacute and chronic cough in adults".)
A cough that is caused by an underlying abnormality or disease is termed a specific cough. The causes of specific chronic cough fall into the following general categories (table 1):
- Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax 2008; 63 Suppl 3:iii1.
- Chang AB, Van Asperen PP, Glasgow N, et al. Children with chronic cough: when is watchful waiting appropriate? development of likelihood ratios for assessing children with chronic cough. Chest 2015; 147:745.
- Anderson SD, Brannan JD. Methods for "indirect" challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols. Clin Rev Allergy Immunol 2003; 24:27.
- Marchant JM, Masters IB, Taylor SM, Chang AB. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax 2006; 61:694.
- Craven V, Everard ML. Protracted bacterial bronchitis: reinventing an old disease. Arch Dis Child 2013; 98:72.
- Lim MT, Jeyarajah K, Jones P, et al. Specific antibody deficiency in children with chronic wet cough. Arch Dis Child 2012; 97:478.
- Marchant JM, Masters IB, Taylor SM, et al. Evaluation and outcome of young children with chronic cough. Chest 2006; 129:1132.
- Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008; 43:519.
- Zgherea D, Pagala S, Mendiratta M, et al. Bronchoscopic findings in children with chronic wet cough. Pediatrics 2012; 129:e364.
- Marchant JM, Morris P, Gaffney JT, Chang AB. Antibiotics for prolonged moist cough in children. Cochrane Database Syst Rev 2005; :CD004822.
- Marchant J, Masters IB, Champion A, et al. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax 2012; 67:689.
- Chang AB, Oppenheimer JJ, Weinberger M, et al. Children With Chronic Wet or Productive Cough--Treatment and Investigations: A Systematic Review. Chest 2016; 149:120.
- Goyal V, Grimwood K, Marchant J, et al. Does failed chronic wet cough response to antibiotics predict bronchiectasis? Arch Dis Child 2014; 99:522.
- Chang AB, Asher MI. A review of cough in children. J Asthma 2001; 38:299.
- Chang AB, Connor FL, Petsky HL, et al. An objective study of acid reflux and cough in children using an ambulatory pHmetry-cough logger. Arch Dis Child 2011; 96:468.
- Khoshoo V, Edell D, Mohnot S, et al. Associated factors in children with chronic cough. Chest 2009; 136:811.
- Borrelli O, Marabotto C, Mancini V, et al. Role of gastroesophageal reflux in children with unexplained chronic cough. J Pediatr Gastroenterol Nutr 2011; 53:287.
- Blondeau K, Mertens V, Dupont L, et al. The relationship between gastroesophageal reflux and cough in children with chronic unexplained cough using combined impedance-pH-manometry recordings. Pediatr Pulmonol 2011; 46:286.
- Ghezzi M, Guida E, Ullmann N, et al. Weakly acidic gastroesophageal refluxes are frequently triggers in young children with chronic cough. Pediatr Pulmonol 2013; 48:295.
- Rosen R, Amirault J, Johnston N, et al. The utility of endoscopy and multichannel intraluminal impedance testing in children with cough and wheezing. Pediatr Pulmonol 2014; 49:1090.
- Chang AB, Lasserson TJ, Gaffney J, et al. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 2011; :CD004823.
- Higuchi O, Adachi Y, Itazawa T, et al. Relationship between rhinitis and nocturnal cough in school children. Pediatr Allergy Immunol 2012; 23:562.
- Chang AB, Glomb WB, ). Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest 2006; 129:260S.
- Harnden A, Grant C, Harrison T, et al. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ 2006; 333:174.
- Chang AB. Cough, cough receptors, and asthma in children. Pediatr Pulmonol 1999; 28:59.
- Gibson PG, Simpson JL, Chalmers AC, et al. Airway eosinophilia is associated with wheeze but is uncommon in children with persistent cough and frequent chest colds. Am J Respir Crit Care Med 2001; 164:977.
- Thomson F, Masters IB, Chang AB. Persistent cough in children and the overuse of medications. J Paediatr Child Health 2002; 38:578.
- Wright AL, Holberg CJ, Morgan WJ, et al. Recurrent cough in childhood and its relation to asthma. Am J Respir Crit Care Med 1996; 153:1259.
- Chang AB, Gibson PG, Willis C, et al. Do sex and atopy influence cough outcome measurements in children? Chest 2011; 140:324.
- Butani L, O'Connell EJ. Functional respiratory disorders. Ann Allergy Asthma Immunol 1997; 79:91.
- Irwin RS, Glomb WB, Chang AB. Habit cough, tic cough, and psychogenic cough in adult and pediatric populations: ACCP evidence-based clinical practice guidelines. Chest 2006; 129:174S.
- Lokshin B, Lindgren S, Weinberger M, Koviach J. Outcome of habit cough in children treated with a brief session of suggestion therapy. Ann Allergy 1991; 67:579.
- Vertigan AE, Murad MH, Pringsheim T, et al. Somatic Cough Syndrome (Previously Referred to as Psychogenic Cough) and Tic Cough (Previously Referred to as Habit Cough) in Adults and Children: CHEST Guideline and Expert Panel Report. Chest 2015; 148:24.
- Tan H, Büyükavci M, Arik A. Tourette's syndrome manifests as chronic persistent cough. Yonsei Med J 2004; 45:145.
- Duncan KL, Faust RA. Tourette syndrome manifest as chronic cough. Int J Pediatr Otorhinolaryngol 2002; 65:65.
- Tekdemir I, Aslan A, Elhan A. A clinico-anatomic study of the auricular branch of the vagus nerve and Arnold's ear-cough reflex. Surg Radiol Anat 1998; 20:253.
- Jegoux F, Legent F, Beauvillain de Montreuil C. Chronic cough and ear wax. Lancet 2002; 360:618.
- Centers for Disease Control and Prevention (CDC). Infant deaths associated with cough and cold medications--two states, 2005. MMWR Morb Mortal Wkly Rep 2007; 56:1.
- Schroeder K, Fahey T. Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 2004; :CD001831.
- Public Health Advisory. Nonprescription cough and cold medicine use in children. Available at: http://www.fda.gov/Drugs/DrugSafety/PublicHealthAdvisories/ucm051282.html (Accessed on November 07, 2007).
- Gardiner SJ, Chang AB, Marchant JM, Petsky HL. Codeine versus placebo for chronic cough in children. Cochrane Database Syst Rev 2016; 7:CD011914.
- Chung KF, Chang AB. Therapy for cough: active agents. Pulm Pharmacol Ther 2002; 15:335.
- The US guidelines are available online: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on October 22, 2009).
- The international guidelines are available online: www.ginasthma.com (Accessed on October 22, 2009).
- Brand PL, Duiverman EJ. [Coughing and wheezing children: improvement after parents stop smoking]. Ned Tijdschr Geneeskd 1998; 142:825.
- Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. Pediatrics 2007; 120:855.
- Anbar RD, Hall HR. Childhood habit cough treated with self-hypnosis. J Pediatr 2004; 144:213.
- SPECIFIC COUGH
- Protracted bacterial bronchitis
- - Differential diagnosis of PBB
- - Treatment of PBB
- Chronic suppurative lung disease and bronchiectasis
- Foreign body
- - Gastroesophageal reflux
- - Upper airway cough syndrome
- - Postpertussis cough
- NONSPECIFIC (ISOLATED) COUGH
- Cough-dominant asthma
- Increased cough receptor sensitivity
- Tic cough
- Otogenic cough
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS