CHRONIC COUGH
DEFINITION:
A cough in an infant or child lasting 3 to 4 weeks.
EPIDEMIOLOGY:
- incidence: common
- age of onset:
- risk factors:
- see differential diagnosis
DIFFERENTIAL DIAGNOSIS:
- Rhinitis (Allergic or Vasomotor)
- Post Nasal Drip
- Adenoids
- Sinusitis
2. Foreign Body Aspiration
2. Lower Airway
- Laryngotracheoesophageal Cleft
- Laryngocele
- Laryngeal Foreign Body
- Tracheomalacia +/- Aberrant Mediastinal Vessels
- Tracheoesophageal Fistula
- Bronchogenic Cyst
- Cystic Fibrosis
- Primary Ciliary Dyskinesis
- Bronchiolitis Obliterans
- Cystic Adenoid Malformation
- Congenital Lobar Emphysema
- Pulmonary Sequestration
- Idiopathic Pulmonary Hemosiderosis
- Eventration of the Diaphragm
- Congenital Mediastinal Tumors
2. Infectious
2. Bacterial
- Bordetella pertussis, Chlamydia trachomatis, myco-plasma,
Pneumocystis carinii, Ureaplasma urealyticum
3. Granulomatous
3. Inflammatory
- CHRONIC COUGH
- Reactive Airway Disease (Asthma)
4. Others
- Foreign Body Aspiration
- Irritants
- cigarette smoke (passive or active)
- dry and dusky environment
- volatile chemicals
3. Others
- Congenital Heart Disease
- Aortic Arch Anomalies
- Double Aortic Arch, Right Aortic Arch with Left
Lig-amentum Arteriosum, Anomalous Innominate Artery,
Aberrant Right Subclavian Artery, Vascular Sling
2. Gastrointestinal
- Tracheoesophageal Fistula (H-Type)
- GE Reflux
3. Immunodeficiency Syndromes
- Bruton Disease
- Common Variable Immunodeficiency
- Severe Combined Immunodeficiency Diseases
4. Others
- Neurodevelopmental Defect with Aspiration
- Pyschogenic or Habit Cough
CLINICAL FEATURES:
- pneumonia - chlamydia, pertussis, CMV
2. Foreign Body Aspiration
- may be a latent period between onset of cough and time of
aspiration
3. Psychogenic
- barking, honking, seal-like, non-productive, explosive,
isolated (1 cough)
- can occur up to 60 times per hour
- absent during sleep
- worse when under stress or attention drawn to cough
- may or may not be associated with tics or school phobia
4. Productive
- likely to have suppurative lung disease, i.e., CF,
bronchiectasis, infectious pneumonia
- bloody - foreign body, CF, Idiopathic Pulmonary
Hemosid-erosis, TB
5. Nighttime
- non-productive - postnasal secretions, bronchospasm
2. Timing
- productive - bronchiectasis, CF
2. During or After Feeds
- Laryngotracheoesophageal Cleft, Tracheoesophageal Fistula,
GE Reflux, Neurodevelopmental Defect, Aortic Arch Anomalies
3. Seasonal
- Spring/Summer - allergies, asthma
- Fall - asthma
- Winter - recurrent viral infections, dry environment
3. Associated Symptoms
2. Aphonia
3. Allergic Symptoms
- conjunctivitis, atopic dermatitis, allergic shiners,
serous otitis media, Dennie's sign, hypertrophic lymphoid
follicles
4. Failure to Thrive
- chronic diseases, i.e., CF, suppurative lung disease
5. Shortness of Breath
- pleural effusions, pneumothorax, trauma, congenital heart
disease
INVESTIGATIONS:
- to rule out congenital anomalies, congenital heart
disease, foreign bodies
- will be normal in 15-20% with a bronchial foreign body
and in 60% of those with a tracheal/laryngeal foreign body
2. Lateral Neck X-Ray
2. Blood
- eosinophilia, immunodeficiency
3. Sweat Test
- to rule out Cystic Fibrosis
4. Pulmonary Function Tests
2. Second Line Investigations
- inspiratory and expiratory films to detect foreign
bodies
2. Angiogram
- to rule out vascular or congenital pulmonary anomalies
3. Fluoroscopy
- mediastinum moves towards the lesion on inspiration
4. Others
- Barioum Swallow or Esophagram
- Flexible Fiberoptic Bronchoscopy
- V/Q Scan
2. Nasal Smear
MANAGEMENT:
- remove stimulants and irritants
- humidified air
2. Cough Suppressants
- little gained by treating the cough without treating the
underlying cause
- acute treatment
- codeine, dextromethorphan, noscapine
- CoACTIFED (Triprolidine, Codeine, Pseudoephedrine)
- TRIAMINIC-DM (Dextromethorphan, Guaifenesin)
- DORCOL DM (Dextromethorphan)
3. Treat Underlying Disorder
- Asthma
- Congenital Anomalies
- Rhinitis
- antihistamines, decongestants
- Seldane, Claritan
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