Evaluation of Chronic Cough in Children

Asilsoy S, Bayram E, Agin H, et al. Chest. 2008;134(6):1122–1128

PURPOSE OF THE STUDY. To evaluate chronic cough in children in accordance with the 2006 American College of Chest Physicians (ACCP) guidelines.

STUDY POPULATION. The study included 108 children between 6 and 14 years of age who presented with a cough lasting >4 weeks.

METHODS. Using the algorithm suggested by the ACCP guidelines for chronic cough in children, a detailed history was obtained and a physical examination was completed. Patients were reevaluated at 2- to 4-week intervals. All patients underwent pulmonary function testing and chest radiography. Additional testing was performed as clinically indicated. Patients were classified into the following diagnostic categories: (1) asthma and asthma-like symptoms, (2) protracted bronchitis, (3) gastroesophageal reflux disease (GERD), (4) upper airway cough syndrome (UACS), (5) natural recovery, (6) bronchiectasis, (7) tuberculosis, and (8) Mycloplasma pneumoniae infection.

RESULTS. The most common causes of chronic cough in this age group were asthma plus asthma-like symptoms (25%), protracted bronchitis (23.4%), and UACS (formerly postnasal drip) (20.3%). GERD accounted for <5% of cases.

CONCLUSIONS. The authors concluded that ACCP guidelines for the management of chronic cough in children were effective. This study demonstrated the importance of the “watch, wait, and review” step. When therapy is initiated, the response to treatment should be evaluated at 2- to 4-week intervals, to prevent unnecessary evaluation of chronic cough. The causes of cough in children differ from the causes in adults. The evaluation of cough in children should include asthma, bronchitis, and UACS in the differential diagnosis. When treatment is initiated, a detailed investigation should be made for patients who do not respond to the treatment.

REVIEWERS COMMENTS. Chronic cough in children is a common problem, and the most common causes are slightly different from those in adults, for whom GERD is listed in the top 3 causes. In this study, the authors concluded that GERD could be the result of cough and not just the cause. In this study, asthma and asthma-like symptoms were the most common cause. This may be attributable to the age of the participants. Previous studies in children included participants <2 years of age, for whom the diagnosis of asthma is more difficult. Observing and reevaluating children every 2 to 4 weeks when they present with chronic cough may decrease the need for extensive testing.

• Copyright © 2009 by the American Academy of Pediatrics