Chronic cough is common in kids, affecting their sleep, school attendance and play, leaving parents somewhat concerned and in repeat GP consultations.
Leading paediatric pulmonologist Dr Atul Gupta shares his advice on managing the condition in children by understanding the symptoms and the possible causes.
What is chronic cough?
Chronic cough is defined as a non-resolving daily cough lasting longer than 4-6 weeks. Most cases of cough relate to the respiratory infections that would be expected in an otherwise healthy child. In children with a chronic cough, it is important to exclude asthma syndrome or protracted bacterial bronchitis.
What causes serious chronic cough?
The most common causes of a child’s cough are allergic rhinitis, chronic sinusitis, asthma and whooping cough (pertussis), which are often considered first. The more serious conditions that may present with a chronic cough, include:
- Cystic fibrosis
- Chronic suppurative lung disease - bronchiectasis
- Immune deficiencies
- Primary ciliary disorders – a genetic condition where the cells in the respiratory system (cilia) do not function normally.
- Recurrent pulmonary aspiration
- Retained inhaled foreign body – an object is inhaled and is lodged in the child’s airway or lungs.
- Interstitial lung diseases – a general category, which includes many different lung conditions such as sarcoidosis and interstitial pneumonia.
- Cardiac disease
How is a chronic cough in children treated?
Management of an otherwise well child with a persistent, dry non-productive cough includes reassurance and monitoring. Most coughs are post-viral and will resolve spontaneously. In children with a chronic dry cough, a trial of inhaled corticosteroid (ICS) can be considered. A high proportion of children would improve irrespective of treatment. Upon improvement, the ICS should stop and a diagnosis of asthma should only be made if a cough reoccurs.
Children with a chronic wet cough, who are otherwise well, may have protracted bacterial bronchitis, a chronic infection of the conducting airways, with high incidence in the preschool age group. A prolonged course of a broad-spectrum antibiotic is appropriate first-line management. This should be followed by review and onward referral if a cough persists.
What tips can you give on managing chronic cough?
Careful evaluation of a chronic cough is crucial. Don’t delay and contact a respiratory paediatrician for a diagnosis.