Childhood chronic cough made easy: a simplified approach for the primary care setting
Main Article Content
Keywords
cough, children, chronic cough, cough syndromes, diagnostic algorithm
Abstract
Cough is a defense mechanism, but when it becomes persistent and troublesome, it must be carefully assessed. Chronic cough, that is, cough persisting for more than 4 weeks, has a proven negative impact on a child’s quality of life; it interferes with daily activities, sleep, and schooling and may involve frequent health care visits and long-lasting treatments. Currently, there is a plethora of algorithms in the literature aiming to assist in the assessment of chronic cough in children; however, referring to complex flowcharts may be impractical for the usually busy primary care physician. Herein, we provide a simplified tool for the assessment of children with chronic cough in the primary care setting, presenting a basic approach to the most common causes along with hints to avoid common pitfalls in everyday practice. Finally, the most common clinical scenarios are analyzed, aiming to assist primary care physicians in providing the appropriate care to these patients.
References
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24. Selvadurai H. Investigation and management of suppurative cough in pre-school children. Paediatr Respir Rev. 2006 Mar;7(1):15–20. 10.1016/j.prrv.2005.11.001
25. Tatar M, Plevkova J, Brozmanova M, Pecova R, Kollarik M. Mechanisms of the cough associated with rhinosinusitis. Pulm Pharmacol Ther. 2009;22(2):121–126. 10.1016/j.pupt.2008.11.014
26. Achilleos A. Evidence-based evaluation and management of chronic cough. Med Clin North Am. 2016;100(5):1033–1045. 10.1016/j.mcna.2016.04.008
27. Vertigan AE. Somatic Cough Syndrome (previously referred to as psychogenic cough) and Tic Cough (previously referred to as habit cough) in adults and children. CHEST Guideline and Expert Panel Report. Chest. 2015;148(1):24–31. 10.1378/chest.15-0423
28. Fraga JC, Jennings RW, Kim PC. Pediatric tracheomalacia. Semin Pediatr Surg. 2016;25(3):156–164. 10.1080/09362835.2016.1237233
29. Wu J, Zhong W, Yin Y, Zhang H. Primary immunodeficiency disease: a retrospective study of 112 Chinese children in a single tertiary care center. BMC Pediatr. 2019;19(1):410. 10.1186/s12887-019-1729-7
30. Fouzas S, Anthracopoulod MB, Bohadana A. Clinical usefulness of breath sounds. In: Priftis KN, Hadjileontiadis L, Everard M, editors. Breath sounds. Cham, Switzerland: Springer; 2018. p. 33–52.
31. Kantar A. Phenotypic presentation of chronic cough in children. J Thorac Dis. 2017;9(4):907–913. 10.21037/jtd.2017.03.53
32. Yang CL, Gaffin JM, Radhakrishnan D. Question 3: Can we diagnose asthma in children under the age of 5 years? Paediatr Respir Rev. 2019;29:25–30. 10.1016/j.prrv.2018.10.003
33. Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax. 2006;61: 694–698. 10.1136/thx.2005.056986
34. Overlack A. ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms and management. Drug Saf. 1996;15(1):72–78. 10.2165/00002018-199615010-00006
35. Fouzas S, Priftis KN, Anthracopoulos MB. Pulse oximetry in pediatric practice. Pediatrics. 2011;128(4):740–752. 10.1542/peds.2011-0271
36. Kantar A, Chang AB, Shields MD, Marchant JM, Grimwood K, Grigg J, et al. ERS statement on protracted bacterial bronchitis in children. Eur Respir J. 2017;50(2):pii:1602139. 10.1183/13993003.02139-2016
37. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R British Thoracic Society Cough Guideline Group. BTS guidelines: recommendations for the assessment and management of cough in children. Thorax. 2008;63Suppl 3:iii1–iii15. 10.1136/thx.2007.077370
38. Chang AB, Bell SC, Torzillo PJ, King PT, Maguire GP, Byrnes CA, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust. 2015;16;202(3):130. 10.5694/mjac14.00287
39. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society Technical statement. Am J Respir Crit Care Med. 2019;200(8):e70–e88. 10.1164/rccm.201908-1590ST
40. Majid A, Sosa AF, Ernst A, Feller-Kopman D, Folch E, Singh AK, et al. Pulmonary function and flow-volume loop patterns in patients with tracheobronchomalacia. Respir Care. 2013;58(9): 1521–1526. 10.4187/respcare.02277
41. Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Turktas I. Children with chronic nonspecific isolated cough. Chest. 2014;145:1279–1285. 10.1378/chest.13-2348
42. Vertigan AE. Somatic cough syndrome or psychogenic cough –What is the difference? J Thorac Dis. 2017;9(3):831–838. 10.21037/jtd.2017.03.119
43. Chang AB, Upham JW, Masters IB, Redding GR, Gibson PG, Marchant JM, et al. Protracted bacterial bronchitis: the last decade and the road ahead. Pediatr Pulmonol. 2016;51:225–242. 10.1002/ppul.23351
44. Marhant JM, Masters IB, Champion A, Petsky HL, Chang AB. Randomised controlled trial of amoxicillin clavulanate in children with chronic wet cough. Thorax. 2012;67:689–693. 10.1136/thoraxjnl-2011-201506
45. Gilchrist FJ, Carroll W. Protracted bacterial bronchitis: a common problem with no agreed solution. Arch Dis Child. 2017;102(11):1094. 10.1136/archdischild-2017-312976
46. Pritchard MG, Lenney W, Gilchrist FJ. Outcomes in children with protracted bacterial bronchitis confirmed by bronchoscopy. Arch Dis Child. 2015;100(1):112. 10.1136/archdischild-2014-307284
47. Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Petsky HL, Smith-Vaughan H, et al. Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis. Chest. 2016;150(5):1101–1108. 10.1016/j.chest.2016.06.030
2. Newcombe PA, Sheffield JK, Juniper EF, Petsky HL, Willis C, Chang AB. Validation of a parent-proxy quality of life questionnaire for paediatric chronic cough (PC-QOL). Thorax. 2010; 65(9):819–823. 10.1136/thx.2009.133868
3. Song WJ, Chang YS, Faruqi S, Kang MK, Kim JY, Kang MG, et al. Defining chronic cough: a systematic review of the epidemiological literature. Allergy Asthma Immunol Res. 2016 Mar;8(2):146–155. 10.4168/aair.2016.8.2.146
4. Parks DP, Ahrens RC, Humphries CT, Weinberger MM. Chronic cough in childhood: approach to diagnosis and treatment. J Pediatr. 1989;115(5 Pt 2):856–862. 10.1016/S0022-3476(89)80123-4
5. de Jongste JC, Shields MD. Cough. 2: chronic cough in children. Thorax. 2003;58(11):998–1003. 10.1136/thorax.58.11.998
6. Chang AB, Oppenheimer JJ, Irwin RS; CHEST Expert Cough Panel. Managing chronic cough as a symptom in children and management algorithms: CHEST Guideline and Expert Panel Report. Chest. 2020;pii:S0012-3692(20)30325-1 [Epub ahead of print].
7. Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study. Fam Pract. 2003;20:696–705. 10.1093/fampra/cmg613
8. Hay AD, Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review. Br J Gen Pract. 2002;52:401–409.
9. Chang AB, Robertson CF, Van Asperen PP, Glasgow NJ, Mellis CM, Masters IB, et al. A multicenter study on chronic cough in children: burden and etiologies based on a standardized management pathway. Chest. 2012;142(4): 943–950. 10.1378/chest.11-2725
10. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129:260s–283s. 10.1378/chest.129.1_suppl.260S
11. Gibson PG, Chang AB, Glasgow NJ, Holmes PW, Katelaris P, Kemp AS, et al; CICADA. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian cough guidelines summary statement. Med J Aust. 2010;192(5):265–271. 10.5694/j.1326-5377.2010.tb03504.x
12. Grudniewicz A, Bhattacharyya O, McKibbon KA, Straus SE. Redesigning printed educational materials for primary care physicians: design improvements increase usability. Implement Sci. 2015;10:156. 10.1186/s13012-015-0339-5
13. Chang AB, Oppenheimer JJ, Weinberger M, Grant CC, Rubin BK, Irwin RS; CHEST Expert Cough Panel. Etiologies of chronic cough in pediatric cohorts: CHEST Guideline and Expert Panel Report. Chest. 2017;152(3):607–617. 10.1016/j.chest.2017.06.006
14. Ishak A, Everard ML. Persistent and recurrent bacterial bronchitis–a paradigm shift in our understanding of chronic respiratory disease. Front Pediatr. 2017;5:19. 10.3389/fped.2017.00019
15. Migliori GB, Sotgiu G, Rosales-Klintz S, Centis R, D’Ambrosio L, Abubakar I, et al. ERS/ECDC statement: European Union standards for tuberculosis care, 2017 update. Eur Respir J. 2018;51(5):pii: 1702678. 10.1183/13993003.02678-2017
16. Gilchrist FJ. An approach to the child with a wet cough. Paediatr Respir Rev. 2019;31:75–81. 10.1016/j.prrv.2018.11.002
17. Brodlie M, Graham C, McKean MC. Childhood cough. BMJ. 2012;344:e1177. 10.1136/bmj.e1177
18. Everard ML. ”Suppurative lung disease” in children. Pediatr Respirol Crit Care Med. 2018;2:18–24. 10.4103/prcm.prcm_6_18
19. Weinberger M, Fischer A. Differential diagnosis of chronic cough in children. Allergy Asthma Proc. 2014;35(2):95–103. 10.2500/aap.2014.35.3711
20. Alviani C, Ruiz G, Gupta A. Fifteen-minute consultation: a structured approach to the management of chronic cough in a child. Arch Dis Child Educ Pract Ed. 2018;103(2):65–70. 10.1136/archdischild-2017-313496
21. Xingmei Yu, Lingjun Kong, Wujun Jiang, Yinfang Dai, Yuqing Wang, Li Huang, et al. Etiologies associated with chronic cough and its clinical characteristics in school-age children. J Thorac Dis. 2019;11(7):3093–3102. 10.21037/jtd.2019.07.36
22. Devonshire AL, Kumar R. Pediatric asthma: principles and treatment. Allergy Asthma Proc. 2019;40(6):389–392. 10.2500/aap.2019.40.4254
23. Lee AS, Lee JS, He Z, Ryu JH. Reflux-aspiration in chronic lung disease. Ann Am Thorac Soc. 2020 Feb;17(2):155–164.10.1513/AnnalsATS.201906-427CME
24. Selvadurai H. Investigation and management of suppurative cough in pre-school children. Paediatr Respir Rev. 2006 Mar;7(1):15–20. 10.1016/j.prrv.2005.11.001
25. Tatar M, Plevkova J, Brozmanova M, Pecova R, Kollarik M. Mechanisms of the cough associated with rhinosinusitis. Pulm Pharmacol Ther. 2009;22(2):121–126. 10.1016/j.pupt.2008.11.014
26. Achilleos A. Evidence-based evaluation and management of chronic cough. Med Clin North Am. 2016;100(5):1033–1045. 10.1016/j.mcna.2016.04.008
27. Vertigan AE. Somatic Cough Syndrome (previously referred to as psychogenic cough) and Tic Cough (previously referred to as habit cough) in adults and children. CHEST Guideline and Expert Panel Report. Chest. 2015;148(1):24–31. 10.1378/chest.15-0423
28. Fraga JC, Jennings RW, Kim PC. Pediatric tracheomalacia. Semin Pediatr Surg. 2016;25(3):156–164. 10.1080/09362835.2016.1237233
29. Wu J, Zhong W, Yin Y, Zhang H. Primary immunodeficiency disease: a retrospective study of 112 Chinese children in a single tertiary care center. BMC Pediatr. 2019;19(1):410. 10.1186/s12887-019-1729-7
30. Fouzas S, Anthracopoulod MB, Bohadana A. Clinical usefulness of breath sounds. In: Priftis KN, Hadjileontiadis L, Everard M, editors. Breath sounds. Cham, Switzerland: Springer; 2018. p. 33–52.
31. Kantar A. Phenotypic presentation of chronic cough in children. J Thorac Dis. 2017;9(4):907–913. 10.21037/jtd.2017.03.53
32. Yang CL, Gaffin JM, Radhakrishnan D. Question 3: Can we diagnose asthma in children under the age of 5 years? Paediatr Respir Rev. 2019;29:25–30. 10.1016/j.prrv.2018.10.003
33. Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax. 2006;61: 694–698. 10.1136/thx.2005.056986
34. Overlack A. ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms and management. Drug Saf. 1996;15(1):72–78. 10.2165/00002018-199615010-00006
35. Fouzas S, Priftis KN, Anthracopoulos MB. Pulse oximetry in pediatric practice. Pediatrics. 2011;128(4):740–752. 10.1542/peds.2011-0271
36. Kantar A, Chang AB, Shields MD, Marchant JM, Grimwood K, Grigg J, et al. ERS statement on protracted bacterial bronchitis in children. Eur Respir J. 2017;50(2):pii:1602139. 10.1183/13993003.02139-2016
37. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R British Thoracic Society Cough Guideline Group. BTS guidelines: recommendations for the assessment and management of cough in children. Thorax. 2008;63Suppl 3:iii1–iii15. 10.1136/thx.2007.077370
38. Chang AB, Bell SC, Torzillo PJ, King PT, Maguire GP, Byrnes CA, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust. 2015;16;202(3):130. 10.5694/mjac14.00287
39. Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society Technical statement. Am J Respir Crit Care Med. 2019;200(8):e70–e88. 10.1164/rccm.201908-1590ST
40. Majid A, Sosa AF, Ernst A, Feller-Kopman D, Folch E, Singh AK, et al. Pulmonary function and flow-volume loop patterns in patients with tracheobronchomalacia. Respir Care. 2013;58(9): 1521–1526. 10.4187/respcare.02277
41. Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Turktas I. Children with chronic nonspecific isolated cough. Chest. 2014;145:1279–1285. 10.1378/chest.13-2348
42. Vertigan AE. Somatic cough syndrome or psychogenic cough –What is the difference? J Thorac Dis. 2017;9(3):831–838. 10.21037/jtd.2017.03.119
43. Chang AB, Upham JW, Masters IB, Redding GR, Gibson PG, Marchant JM, et al. Protracted bacterial bronchitis: the last decade and the road ahead. Pediatr Pulmonol. 2016;51:225–242. 10.1002/ppul.23351
44. Marhant JM, Masters IB, Champion A, Petsky HL, Chang AB. Randomised controlled trial of amoxicillin clavulanate in children with chronic wet cough. Thorax. 2012;67:689–693. 10.1136/thoraxjnl-2011-201506
45. Gilchrist FJ, Carroll W. Protracted bacterial bronchitis: a common problem with no agreed solution. Arch Dis Child. 2017;102(11):1094. 10.1136/archdischild-2017-312976
46. Pritchard MG, Lenney W, Gilchrist FJ. Outcomes in children with protracted bacterial bronchitis confirmed by bronchoscopy. Arch Dis Child. 2015;100(1):112. 10.1136/archdischild-2014-307284
47. Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Petsky HL, Smith-Vaughan H, et al. Protracted bacterial bronchitis in children: natural history and risk factors for bronchiectasis. Chest. 2016;150(5):1101–1108. 10.1016/j.chest.2016.06.030
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Mar 1, 2021
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Chatziparasidis, G., Fouzas, S., & Kantar, A. (2021). Childhood chronic cough made easy: a simplified approach for the primary care setting. Allergologia Et Immunopathologia, 49(2), 170-177. https://doi.org/10.15586/aei.v49i2.38
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How to Cite
Chatziparasidis, G., Fouzas, S., & Kantar, A. (2021). Childhood chronic cough made easy: a simplified approach for the primary care setting. Allergologia Et Immunopathologia, 49(2), 170-177. https://doi.org/10.15586/aei.v49i2.38