Paediatrics: Common presentation: cough

2021-03-04 12:00 AM

Cough is a protective response for removing secretions and particulate matter from the airway. Main feature sudden expulsion of air from the lungs.

Common presentation: cough

 

Cough is a protective response for removing secretions and particulate matter from the airway. Main feature sudden expulsion of air from lungs.

 

Differential diagnosis of acute cough

Upper airway disease

  • Common cold: e.g., rhinovirus.
  • Other infections: e.g. viral influenza and parainfluenza, sinusitis, tonsillitis,laryngitis, croup.
  • Allergy.
  • Vocal cord dysfunction.

Lower airway disease

  • Asthma.
  • Infection: e.g. respiratory syncytial virus bronchiolitis, bronchitis due toadenovirus, influenza, and parainfluenza.

Lung parenchymal disease

  • Infection: e.g. viral and bacterial pneumonia, empyema.
  • Atypical pneumonia: e.g.Mycoplasma pneumoniae infection.

Treatment 

In general, we do not treat cough, but focus on underlying cause.

Differential diagnosis of chronic cough

A chronic cough is one that has persisted for more than 8wks (British Thoracic Society 2008 guideline1 for the assessment and management of children with chronic cough). Its causes are as follows:

Upper airway disease:

  • infection—e.g. chronic sinusitis, tonsillitis,Bordetella pertussis;
  • inflammation—e.g. gastro-oesophageal reflux.

Lower airway disease:

  • congenital abnormalities—e.g. tracheo-oesophageal fistula, cleftlarynx, pulmonary artery sling;
  • asthma;
  • infection: e.g. post-bronchiolitis symptoms, atypical infections;
  • foreign body
  • bronchiectasis: e.g. damage to the airway from chronic infection and tuberculosis or immunodeficiency;
  • cystic fibrosis.

Lung parenchymal disease: infection, e.g. pneumonia and empyema.

Central causes:

  • Psychogenic cough.
  • Tourette disease: with a tic involving throat clearing or cough.

Treatment: in common with acute cough, when treating chronic cough, try and identify the underlying cause and focus on its treatment