Analysis of the Literature on Chronic Cough in Children

Abstract

Throughout childhood, various developmental phenomena influence the cough reflex. Among these are the modifications in the anatomy and functions of the respiratory tract and the central and peripheral nervous systems. Moreover, after birth, the immunological response undergoes progressive transformations with the acquisition of immune memory processes. These conditions make infections and airway abnormalities the overwhelming cause of chronic cough in children and infants. In children, chronic cough should be treated on the basis of etiology. The aim of this article is to provide thorough research and analysis of the medical literature published up to 2014 on chronic cough in children as a disease entity, including the epidemiologic, etiologic, diagnostic, prognostic, and therapeutic aspects.Our results demonstrate differences in the definition of chronic cough, the characteristics of diagnostic procedures, study settings, and prevalence of the main causes. However, few studies regarding epidemiology and the quality of life have been reported. Many therapeutic approaches that are considered effective in adults with chronic cough seem to be less efficient in children. Regardless of the setting, whether pediatric or non-pediatric, children with chronic cough should be carefully evaluated using child-specific protocols and algorithms. Awareness of the various pathophysiological conditions associated with chronic cough is vital for making a correct diagnosis and providing appropriate treatment. The prevalence of the different causes of chronic cough depends on various issues. Among these are the population under consideration and its age range, infectious disease control and prevention, the diagnostic procedures employed, disease definition criteria, and the local health system. Clinical guidelines for the management of children with chronic cough should take these components into consideration. Further clinical and basic research studies are still needed for better diagnosis, treatment, and prevention of chronic cough in children.

Cough Variant Asthma as a Phenotype of Classic Asthma

“…Namely, in conditions such as postnasal drip induced cough, gastroesophageal reflux associated cough and atopic cough bronchodilators have no antitussive effect [7,26].…”

“…Chronic cough is defined as lasting more than 4 weeks in children and more than 8 weeks for adults [26,[28][29][30]. Diagnosis and management of patients with chronic cough are challenging for clinicians.…”

“…Besides asthma and CVA in adult patients with chronic cough in the differential diagnosis, smoking and ACE-I induced a cough should always be considered [30]. Less common conditions include heart failure, interstitial lung disease, tuberculosis and primary lung cancer [26,29,31].…”

“…In adults, the clinicians need to be attentive to two high-yield elements of the history patients: the use of an angiotensin-converting enzyme inhibitor (ACE-I) and cigarette smoking. Of equal importance is to inquire about exposure to second-hand smoke in children [25,26,31]. Most appropriated algorithm for children can be found in a review article by Chang et al [25].…”

Utilização de Xaropes para a Tosse em Idade Pediátrica

“…3,4 O reflexo da tosse pode ser inibido por supressores do centro reflexo (sedativos, narcóticos), bloqueio dos recetores (aspiração crónica), diminuição da força muscular (doenças neuromusculares) ou disfunção glótica (paralisia das cordas vocais, entubação traqueal ou traqueostomia, broncomalácia ou traqueomalácia). 2,5 A ausência de tosse é um problema consideravelmente grave, que pode levar a fenómenos de aspiração e acumulação de secreções, com complicações pulmonares importantes. 2,5,6 A tosse é, isoladamente, na idade pediátrica, motivo de atendimento médico em 10% a 15% das situações de consulta ou urgência.…”