Cough

Ajay S. Kasi; Rory J. Kamerman-Kretzmer

doi:10.1542/pir.2018-0116

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Ajay S. Kasi, MD*
Rory J. Kamerman-Kretzmer, MD^†

^*Division of Pediatric Pulmonology, Department of Pediatrics, Emory University, Atlanta, GA
^†Division of Pediatric Pulmonology and Sleep Medicine, Children’s Hospital Los Angeles, Los Angeles, CA

AUTHOR DISCLOSURE
Drs Kasi and Kamerman-Kretzmer have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

BAL:: bronchoalveolar lavage
CT:: computed tomography
GERD:: gastroesophageal reflux disease
ICS:: inhaled corticosteroid
OTC:: over-the-counter
PBB:: protracted bacterial bronchitis
PCD:: primary ciliary dyskinesia
URTI:: upper respiratory tract infection

Practice Gaps

Cough in children is a common chief complaint. It is important to adopt a systematic approach to the evaluation and management of chronic cough and avoid symptomatic treatment. The use of pediatric-specific cough management algorithms improves clinical outcomes.

Objectives

After completing this article, readers should be able to:

Distinguish between acute and chronic cough in children.
Identify cough characteristics and specific cough “pointers” requiring further evaluation.
Effectively begin management of nonspecific cough and suspected protracted bacterial bronchitis.
Identify children with cough who need evaluation by a specialist.

Introduction

Cough is a common reason for pediatric outpatient visits. Cough as a manifestation of respiratory disease can range from minor upper respiratory tract infections to serious conditions such as bronchiectasis. Acute cough in children is mostly caused by upper respiratory tract infections (URTIs). Chronic cough, defined as daily cough of at least 4 weeks in duration, (1) can be associated with an underlying serious disorder and, hence, requires systematic and thorough clinical evaluation. There is high-quality evidence that a systematic approach to the management of chronic cough in children using pediatric-specific cough algorithms improves clinical outcomes. (1) Treatment of cough should be based on the etiology. Because cough is a common presenting complaint, pediatricians must become familiar with the initial evaluation and management of children with cough to establish a diagnosis and determine appropriate therapy.

Epidemiology

Cough is one of the most common complaints presented at physician visits and accounts for an estimated 29.5 million annual outpatient visits. (2) The prevalence of chronic cough in children is estimated to be 5% to 10%. (3) In the United States, approximately 2 billion dollars per year is …