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.
·Common cold: e.g., rhinovirus.
·Other infections: e.g. viral influenza and parainfluenza, sinusitis, tonsillitis, laryngitis, croup.
·Vocal cord dysfunction.
·Infection: e.g. respiratory syncytial virus bronchiolitis, bronchitis due to adenovirus, influenza, and parainfluenza.
·Infection: e.g. viral and bacterial pneumonia, empyema.
·Atypical pneumonia: e.g. Mycoplasma pneumoniae infection.
In general, we do not treat cough, but focus on underlying cause.
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;
· 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.
· 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