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 |

Physiology of Cough
The anatomical structures of the respiratory tract are very sensitive structures
- Larynx and Carina – especially sensitive (gateway to trachea and L + R main bronchus)
- Trachea and Bronchi – very sensitive to light touch, a small amount of irritation can initiate the reflex
- Terminal bronchioles and Alveoli – chemically sensitive to corrosive chemicals such as sulphur dioxide and chlorine gas
Approach
- History
- Examination
- +/-Investigations
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 |
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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 |
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Allergic rhinitis |
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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 |
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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 |
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Post-nasal drip |
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Bronchiectasis |
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Remember The most common causes of chronic cough in children are asthma, respiratory tract infections, and gastroesophageal reflux disease. |
Management

Management of persistent cough
Well child, normal examination
- Watch and see
- Avoid exposure to irritants such as cigarette smoke
- Arrange follow up with paediatrician in 2-3 weeks.
Unwell child or abnormal examination
- These children will need further investigation and treatment and senior advice should be sought
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