Paediatrics: Common presentation: cough

Common presentation: cough

Cough is a protective response for removing secretions and particulate matter from the airway. Main feature sudden expulsion of air from lungs.

Differential diagnosis of acute cough

Upper airway disease

·Common cold: e.g., rhinovirus.

·Other infections: e.g. viral influenza and parainfluenza, sinusitis, tonsillitis, laryngitis, croup.

·Allergy.

·Vocal cord dysfunction.

Lower airway disease

·Asthma.

·Infection: e.g. respiratory syncytial virus bronchiolitis, bronchitis due to adenovirus, influenza, and parainfluenza.

Lung parenchymal disease

·Infection: e.g. viral and bacterial pneumonia, empyema.

·Atypical pneumonia: e.g. Mycoplasma pneumoniae infection.

Treatment 

In general, we do not treat cough, but focus on underlying cause.

Differential diagnosis of chronic cough

A chronic cough is one that has persisted for more than 8wks (British Thoracic Society 2008 guideline¹ for the assessment and management of children with chronic cough). Its causes are as follows:

Upper airway disease:

·  infection—e.g. chronic sinusitis, tonsillitis, Bordetella pertussis;

·  inflammation—e.g. gastro-oesophageal reflux.

Lower airway disease:

·  congenital abnormalities—e.g. tracheo-oesophageal fistula, cleft larynx, pulmonary artery sling;

·  asthma;

·  infection: e.g. post-bronchiolitis symptoms, atypical infections;

·  foreign body

·  bronchiectasis: e.g. damage to the airway from chronic infection and tuberculosis, or immunodeficiency;

·  cystic fibrosis.

Lung parenchymal disease: infection, e.g. pneumonia and empyema.

Central causes:

·  Psychogenic cough.

·  Tourette disease: with a tic involving throat clearing or cough.

Treatment: in common with acute cough, when treating chronic cough, try and identify the underlying cause and focus on its treatment