Approach to chronic cough in children

Abstract

Chronic cough in children is a common reason for healthcare visits and affects between 5% and 10% of children in the general population, as estimated based on parental questionnaires. (1) The definition of chronic cough varies among different guidelines. It is defined as a persistent and unremitting cough lasting more than four weeks in the 2020 CHEST consensus statement. (2) The British Thoracic Society guidelines label chronic cough in children as one that lasts beyond eight weeks, while acknowledging the existence of a prolonged subacute cough that lasts between four and eight weeks. (3) HOW RELEVANT IS THIS TO MY PRACTICE?An increase in health-seeking behaviour has been observed among parents of children with chronic cough in this new era of heightened vigilance and surveillance amid the ongoing global COVID-19 pandemic. Prolonged respiratory symptoms could result in the child being isolated, with grave economic and psychological consequences for all individuals involved in the child's care. In Singapore, the 'stay home' notices and quarantine periods to reduce transmission risks among patients or contacts with respiratory symptoms result in the coughing child missing school and necessitate last-minute changes in caregivers' routines to accommodate caring for the child at home. Potential loss in work hours, productivity and household income can cause additional stress to the caregivers. The impact on the family dyad, such as increased caregiver stress, falling academic performance and anxiety over missing major events if subjected to repeated rounds of medical leave, make it crucial for a clinician to develop a sound approach for the management of children with chronic cough. In this article, we suggest an approach to a child with chronic cough in the primary care setting, common causes of chronic cough in children, and indications for referral to a paediatric respiratory specialist for further evaluation and investigations.

Process of diagnosis and treatment of chronic cough in children at primary hospitals

“…It has a complex and diverse etiology and lacks characteristic clinical manifestations ( 27 , 28 ), which can easily lead to underdiagnosis and misdiagnosis ( 29 , 30 ). Chronic cough not only affects the quality of life of children and parents and increases the socioeconomic burden ( 31 – 33 ), but might also be accompanied by an underlying chronic respiratory disease ( 34 , 35 ). The current process of diagnosis and treatment of chronic cough in children is complicated and highly demanding with specialized technology and equipment ( 1 , 16 , 36 – 38 ), impairing its use for clinical practice in primary hospitals.…”

Eosinophilic Cationic Protein and Immunoglobulin E: Unraveling Biomarkers in Chronic Pediatric Cough

“…Usually, respiratory infections take a protracted course in children with allergies or hypersensitivity, where chronic cough is usually the sole symptom, according to the British Thoracic Society [11]. In line with this, some authors recently discussed approaches to chronic cough in children, defined as longer than 8 weeks [12,13].…”