Managing Chronic Cough as a Symptom in Children and Management Algorithms

Is prolonged wet cough underdiagnosed and improperly treated in preschool children?

“…The median age at onset of wet cough was six vs 10 months and on admission 16 vs 22 months, respectively. These figures fit well with those in the available literature 3‐5 . The symptoms had continued for 8‐9 months before admission, which is a long time at this young age of less than 2 years on average.…”

“…The majority of preschool‐aged children with recurrent episodic or chronic wet cough have protracted bacterial bronchitis (PBB), which is a distinct clinical entity defined by the presence of wet or productive cough for at least 4 weeks without evidence of an underlying illness 3,4 . Tracheo‐ and/or bronchomalacia and gastro‐oesophageal reflux are common in young children with PBB 5 and do not belong to the exclusion criteria 3 .…”

“…Tracheo‐ and/or bronchomalacia and gastro‐oesophageal reflux are common in young children with PBB 5 and do not belong to the exclusion criteria 3 . In the currently available guidelines, children with PBB should be treated with rather long antibiotic courses of 2‐4 weeks 3,4 . Research‐based evidence beyond this recommendation is scarce.…”

Managing Chronic Cough as a Symptom in Children

“…3 The Expert Panel included a reference (reference 17 1 ) that indicated that school phobia and fear of rejection were common precipitating or perpetuating factors for the cough. 1 The conclusions in that reference were based on 32 young adults with chronic cough, 20 of them with a psychiatric disorder. There is no relevance of that data to the Habit Cough syndrome where the mean age is 10 years.…”

“…The Expert Panel suggests in their article that this cough is a tic or a variation of Tourette's syndrome. 1 A father reported to me that both he and his son had Tourette's syndrome that included motor tics and verbal outbursts. His son also had a chronic cough.…”