Chronic Cough
Chronic cough is defined as cough which occurs every day for a duration more than 3 to 4 weeks. It is a very common symptom in children. Most of the times, cough is not due to any serious or worrisome illnesses, however it can be irritating and can interfere with the child’s normal activities and could be a challenge to treat. It is a common and could be the only manifestation of asthma or hyper reactive airway disease. With this overview, we will discuss the likely diagnoses when children, who otherwise appear to be healthy, have troublesome coughing.
It is most important to define the severity of cough precisely and objectively. This could be done as follows:
It is most important to define the severity of cough precisely and objectively. This could be done as follows:
- One can document the number of episodes of cough, which occur daily as an average number.
- Time of the day when it occurs more frequently or oftenly.
- Whether it is associated with food / milk intake
- Whether it worsens or occurs during a particular season
- If wheezing is associated
- If nasal symptoms like nasal discharge, snoring or sleep disturbances are associated
- Whether symptoms are more at school or home
To give an example, one could have a 6 year old male child with symptoms of cough which occur in bouts lasting 2 to 3 minutes, averagely 5 to 6 times a day, almost daily for the previous 20 days. These are more at night time but not associated with any food intake. Child does not have any wheezing or fever. So the most likely diagnosis becomes an allergic cough. If there is a history of repeated such episodes especially associated with seasonal change then the diagnosis is an allergic cough likely childhood asthma. If associated with frequent episodes of running nose or sneezing, it would mean childhood asthma with allergic rhinitis.
The important causative or contributory factors could be:
- Environmental causes like – dampness in the home, use of perfumes, room fresheners, deodorants, indoor pollution
- Family history of atopy or asthma or allergies
- Smoking by any family member in the house - Parental smoking has a direct impact on the child’s health and has shown to be associated with increased prevalence of chronic cough, amounting to more than 50% in children below 11 years of age when both parents are smoking.
- Pets
- Atopy or skin allergies in the child
- Atopy or skin allergies in the child
- Air pollution
Cough in the newborn period could be due to the following reasons:
| Isolated cough: otherwise healthy child | Isolated cough : significant underlying cause |
|---|---|
| Recurrent viral bronchitis | Chronic suppurative lung disease |
| Post-infectious cough | Cystic fibrosis |
| Pertussis-like illness | Immune deficiencies |
| Cough variant asthma | Primary ciliary dyskinesia |
| Postnasal drip | Recurrent pulmonary aspiration |
| Psychogenic cough - Habit (“tic” like); Bizarre honking cough | Retained inhaled foreign body |
| Gastro-oesophageal reflux | Chronic bronchitis |
| TOF=tracheo-oesophageal fistula. | Airways lesion |
| Compression, e.g. tuberculous gland | |
| Malacia, often with viral infection, e.g. TOF cough |
Viral infections, asthma and post infectious cough are the most common causes of isolated cough episodes. Cough could be psychogenic if the child is under any form of stress and needs immediate care and attention. Cough with expectoration could mean serious underlying diseases like cystic fibrosis. Tuberculosis is an important cause of chronic cough and needs to be ruled out.
Cough in the newborn period could be due to the following reasons:
- A congenital defect that could lead to difficulty in feeding and result in aspiration into the lungs.
- Abnormality in lining of the airway causing ciliary dysfunction and resulting in infection for example - cystic fibrosis or primary ciliary abnormality;
- Structural or anatomical abnormality in the airways (e.g. a cyst compressing airway or tracheomalacia); or
- A chronic viral pneumonia (e.g. CMV or Chlamydia) acquired in utero or during the perinatal period.
In case your infant or child has chronic cough, do consult your pediatric pulmonologist for a complete checkup and investigations, and appropriate treatment.