Coughing is a protective reflex, a component of normal respiratory function, it enables irritants and foreign bodies to be expelled from the vulnerable respiratory tract, however it can also be voluntarily generated and therefore has non-reflex elements to assist/enhance with mucocilliary clearance
Defintion Acute cough: present up to 14 days/2 weeks Prolonged acute cough: lasting 2 – 3 weeks Chronic cough: present > 3 weeks |
Watch Video: Physiology of Cough |
The anatomical structures of the respiratory tract are very sensitive structures
Approach
Alarm symptoms |
Prominent dyspnoea, esp. at night or rest |
Recurrent episodes of chronic wet or productive cough |
Systemic Sx: fever, anorexia, wt. loss, failure to thrive |
Feeding difficulties inc. choking or vomiting |
Recurrent pneumonia |
Additional breath sounds |
Abnormal clinical respiratory examination |
Abnormal CXR |
COMMON CAUSES OF COUGH | ||||
Conditions | History | Examination | Workup | Aetiology |
Asthma | Expiratory wheeze | Oxygen, Fluids, bronchodilators +/-inhaled corticosteroids (depends on severity) | Infection | |
Foreign body | Sudden onset, history of choking | Cough, Stridor | CT, bronchoscopy | Foriegn Body |
Viral bronchiolitis | Coryzal symptoms (2-3 days) followed by respiratory distress | Fine inspiratory crackles, expiratory wheeze, fever | Usually non required | RSV |
Acute URTIs | Coryzal symptoms | |||
Allergic rhinitis | ||||
Croup (laryngotracheobronchitis) | Barking cough, coryza | Low-grade fever, nasal flaring, respiratory retractions, stridor | Generally not indicated | Generally not indicated |
Remember Young children develop 6-12 respiratory tract infections per year, usually accompanied by cough. In most children the cough is self-limiting (1-3) weeks |
CAUSES OF CHRONIC COUGH | ||||
Condition | History | Examination | Workup | Aetiology |
Smoking Exposure | Smoking exposure | Not significant | Generally not indicated | Smoking |
GOR/GER | Heartburn present, or if cough is worse at night or after eating specific foods | |||
Sinusitis | Nasal discharge, obstruction, toothache, unilateral facial pain, headache, fever "Sinusitis is not associated with cough" | Tender sinuses, fever, inflamed nasal mucosa, pus exudating from middle meatus, maxillary transillumination | ||
Post-nasal drip | ||||
Bronchiectasis |
Remember The most common causes of chronic cough in children are asthma, respiratory tract infections, and gastroesophageal reflux disease. |
Management
Well child, normal examination
Unwell child or abnormal examination