Managing Chronic Cough as a Symptom in Children and Management Algorithms

Patient Guideline Summary

Publication Date: March 1, 2020

Objective

Objective

This patient summary means to discuss key recommendations from the American College of Chest Physicians for Chronic Cough as a Symptom in Children. It is limited to children and should not be used as a reference for adults.

Overview

Overview

  • A cough is considered “chronic” if it lasts over 4 weeks.
  • A brief list of some causes of coughing includes respiratory infections including pertussis (whooping cough), heartburn from regurgitated stomach contents, asthma, tuberculosis (TB), smoke and other airborne irritants, and chronic lung diseases like cystic fibrosis.
    • More common causes in children differ from more common causes in adults.
    • Chronic coughing in children may also have psychological causes. Examples are “somatic cough disorder” and “tic cough.”
  • This patient summary focuses on identifying the cause of chronic cough in children.

Diagnosis

Diagnosis

  • A chest x-ray and spirometry (a breathing test) before and after treatment with an asthma inhaler should be included in the initial evaluation of a child with a chronic cough.
  • A test for airway sensitivity to irritants may aid the diagnosis.
  • Pertussis should be considered.
  • Whether the cough is dry or productive of sputum (phlegm) influences the direction the evaluation should take.
    • A productive cough is more likely due to infection.
  • The remainder of the evaluation should be guided by the initial findings and parental concerns.
  • Brief trials of treatment can assist in the evaluation.

Treatment

Treatment

  • Airborne irritants like tobacco smoke should be eliminated from the child’s environment.
  • Honey and over-the-counter cough and cold preparations may be used.
    • Codeine-containing medicines should be avoided.
  • Once a final diagnosis is made, specific treatment can begin.
  • Both evaluation and treatment should follow formally validated guidelines published in medical journals.

Abbreviations

  • TB: Tuberculosis

Source Citation

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 Jul;158(1):303-329. doi: 10.1016/j.chest.2020.01.042. Epub 2020 Mar 14. PMID: 32179109.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.