Defining the Cough Spectrum and Reviewing the Evidence for Treating Non-Specific Cough in Children

Abstract

Cough is the most common presenting symptom to medical practitioners to the USA and Australia. Worldwide, the desire to reduce the impact of the symptom of cough is reflected in the billions of dollars spent on over the counter cough medications. Easy to apply and clinically relevant definitions of cough are necessary for effective communication and to progress clinical research. Based on current data, pediatric cough definitions have been formulated on timeframe (acute and chronic), clinical cough characteristics (dry vs wet/productive and classical recognizable cough sounds) and suggestive broad underlying etiology categories (expected cough, specific cough, non-specific cough and protracted bronchitis). These definitions are distinct from adult definitions, as many of adult-type aspects of cough cannot be applied to young children. With the lack of pediatric data, adult data is often inappropriately extrapolated to children.In the second part of this paper, the evidence for and against the use of the various pharmaceuticals (such as OTC medications, antimicrobials, treatment for gastroesophageal reflux and asthma) for cough in children are reviewed. The utility of 'time to response' is important in the management of cough in children to minimize possible associated morbidity of the therapies for non-specific cough.

Outcomes in children treated for persistent bacterial bronchitis

“…Most patients in this study became symptom free, although the report includes few details regarding treatment, other than noting that repeated courses of treatment were required in a significant number. Their patients seemed to have been symptomatic for a shorter period than ours, with a median duration of 6 months (interquartile range (IQR) [3][4][5][6][7][8][9][10][11][12].…”

Cough in Allergic Rhinitis

“…Chronic cough may be classified according to its etiology. By this classification cough is divided into ´expected´ cough, non-specific cough and specific cough; its scientific rationale is discussed elsewhere (Chang, 2005). In expected cough, the cough is anticipated, such as after an acute respiratory tract infection.…”

Guidelines for Evaluating Chronic Cough in Pediatrics

“…11,18,19 The background for justification of the use of these terms has been reviewed elsewhere. 20 Chronic cough in children is defined as a cough of Ͼ 4 weeks duration based on the current data of cough related to acute upper respiratory infections in children. 21,22 This review and the evidence presented are also focused on nonspecific chronic cough (ie, cough in the absence of symptoms outlined in Table 1) as data on specific cough would encompass the entire spectrum of pediatric respiratory disease.…”