Cough in children: Difference between revisions

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==Overview==
==Overview==
[[Cough]] is a common complaint of the [[Pediatrics|pediatric]] population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of [[respiratory]] airways. The word [[Cough|'Cough]]' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, [[anatomical]] location, [[etiology]] and grades of coughs. Stimulation to cough [[receptors]] provokes sensations of coughing through the [[afferent]] pathway via the [[vagus nerve]], central respiratory centers in the upper [[pons]] and [[medulla]], and [[efferent]] pathways via the [[phrenic]] and [[vagus]] branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of [[physical examination]], [[laboratory]], and [[imaging]] investigations. Some of the causes are emergently managed to reduce the [[mortality]] of a child.The mainstay of therapy for cough is supportive. [[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].


==Historical Perspective==
==Historical Perspective==


*The word Cough was first derived from the middle English Coughen or old English Cohhian which was primarily composed of the middle Dutch Kochen and the high middle German Kuchen, in early 14th century.  
*The word [[cough]] was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.
   
   
==Classification==
==Classification==
*Cough in children may be classified or defined according to the duration of presenting complaints, quality and sound,  causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
*1 Duration of Presenting complaints: According to the duration of cough, it can be sub classified into three categories.
**Acute: Cough persists for less than three weeks.
**Subacute: Cough persists for three to eight weeks.
**Chronic: Cough persists for more than eight weeks.


*2. Nature or Quality and sounds: According to the quality and sound cough can be sub classified in to following categories-
*[[Cough]] in children may be classified or defined according to the duration of [[Presenting symptom|presenting]] complaints, quality and sound, and causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
**Dry or Hacking or Nonproductive.
*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub-classified into three categories:
**Wet or productive cough.
**[[Acute]]: < 3 weeks.
**[[Subacute]]: 3 to 8 weeks.
**[[Chronic]]: > 8 weeks.
 
*2. [[Nature]] or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
**[[Dry Cough|Dry]] or Hacking or Nonproductive.
**Wet or [[productive cough]].
**Staccato or short repetitive cough.
**Staccato or short repetitive cough.
**Whooping or paroxysmal violent or spasmodic cough.
**[[Whooping Cough|Whooping]] or paroxysmal violent or spasmodic cough.
**Barking cough: Brassy barking or Honking barking.
**[[Barking cough]]: Brassy barking or Honking barking.
**Phlegmy cough.
**Phlegmy cough.
**Burning cough.
**Burning cough.


*3. Causes of Cough: Based on causes cough is subdivided into following three sub groups-
*3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
**Normal or expected cough.
**Specific cough.
**Specific cough.
**Non-specific cough.
**Nonspecific cough.
**Expected cough or Normal cough.


*4. Anatomic classification on causes of cough: Cough can be produced from different anatomical locations. for example-
*4. [[Anatomic]] classification on the causes of a cough: A cough can be produced from different [[anatomical]] locations. For example:
**Nose and Paranasal sinuses.
**[[Nose]] and [[Paranasal sinus|Paranasal]] sinuses.
**Pharynx.
**[[Pharynx]].
**Larynx.
**[[Larynx]].
**Trachea and Bronchi.
**[[Trachea]] and [[Bronchi]].
**Pulmonary parenchyma.
**[[Pulmonary]] parenchyma.
**Pleura.
**[[Pleura]].
**Mediastinum.
**[[Mediastinum]].
**Heart and blood vessels.
**[[Heart]] and [[Blood vessel|blood vessels]].
**External ear and Tympanic membrane.
**[[External ear]] and [[Tympanic membrane]].
**Esophagus.
**[[Esophagus]].


*5. Grades of cough: Cough can be graded into four main sub categories-<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
*5. Grades of [[cough]]: Cough can be graded into four main sub categories:<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
**Eutussia or Normal.
**Eutussia or Normal.
**Hypertussia or Sensitized.
**Hypertussia or Sensitized.
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**Atussia or Absent.
**Atussia or Absent.


Cough in children can also be classified under infectious (Bacterial, Viral, fungal, Parasitic) or non-infectous categories broadly.  
[[Cough]] in children can also be classified under [[infectious]] ([[Bacterial]], [[Viral|Viral,]] [[fungal]], [[Parasitic]]) or non-infectious categories broadly.


==Pathophysiology==
==Pathophysiology==
*Cough is natural innate primitive reflex that helps in mucocilliary clearance of foreign particles and secretions from respiratory tracts. It is also a defensive mechanism protecting respiratory airways from aspiration of pathogens, particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the cough reflex.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
 
*A [[cough]] is a natural [[Innate immune response|innate]] [[Primitive reflexes|primitive reflex]] that helps in mucocilliary clearance of foreign particles and secretions from [[Respiratory tract|respiratory t]]<nowiki/>racts. It is also a defense mechanism protecting the [[Respiratory|respiratory airway]]<nowiki/>s from [[aspiration]] of [[pathogens]], particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the [[Cough reflex|cough refle]]<nowiki/>x.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (Rapidly adapting receptors, slowly adapting receptors or C-fibers) in [[Respiratory airways]]}}
{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in [[Respiratory airways]]}}
{{Family tree | | | | |:| | | | | }}
{{Family tree | | | | |:| | | | | }}
{{Family tree | | | | B01 | | | |B01=[[Afferent]] pathways: Sensory nerve fibers  via [[Vagus Nerve]] from [[ciliated columnar epithelium]] of upper [[airways]], [[cardiac]] and [[esophageal]] branches from [[diaphragm]] send impulse to central [[cough center]]}}
{{Family tree | | | | B01 | | | |B01=[[Afferent]] pathways: Sensory nerve fibers  via [[Vagus Nerve]] from [[ciliated columnar epithelium]] of upper [[airways]], [[cardiac]] and [[esophageal]] branches from [[diaphragm]] send impulse to central [[cough center]]}}
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{{Family tree | | | | B01 | | | |B01=[[Efferent]] pathways: The [[nucleus retroambigualis]] sends impulse via [[phrenic]] and [[spinal motor nerves]] to [[diaphragm]] and abdominal and [[respiratory muscles]], the [[nucleus ambiguous]] sends impulse to [[larynx]] by [[laryngeal]] branches of [[vagus nerve]] }}
{{Family tree | | | | B01 | | | |B01=[[Efferent]] pathways: The [[nucleus retroambigualis]] sends impulse via [[phrenic]] and [[spinal motor nerves]] to [[diaphragm]] and abdominal and [[respiratory muscles]], the [[nucleus ambiguous]] sends impulse to [[larynx]] by [[laryngeal]] branches of [[vagus nerve]] }}
{{Family tree/end}}
{{Family tree/end}}
*On gross pathology, Bloody, Serous , Mucoid, Rusty, Pink frothy, and Purulent are characteristic findings of sputum produced by coughing.
 
*On microscopic histopathological analysis, Pathogens, RBCs, Leukocytes, epithelial celss are characteristic findings of Sputum produced by coughing.
*On [[gross pathology]], [[Bloody sputum|bloody]], serous , mucoid, rusty, pink frothy, and [[purulent]] are characteristic findings of [[sputum]] produced by [[coughing]].
*On [[microscopic]] [[histopathological]] [[analysis]], [[pathogens]], [[red blood cell|RBC]]<nowiki/>s, [[leukocytes]], [[epithelial cells]] are characteristic findings of [[sputum]] produced by [[coughing]].


==Causes==
==Causes==
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{{familytree/end}}
{{familytree/end}}


According to quality and sound of cough in children, the causes can be classified according to following chart.
According to quality and sound of cough in children, the causes can be classified according to the following chart:


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smokes), [[Post infectious cough]]. }}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smoke), [[Post infectious cough]]. }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Wet or [[productive]] cough |B02=[[Cystic fibrosis]], [[Bronchiectasis]], [[Bronchiolitis]], [[Tuberculosis]], [[Rhinitis]], [[Postnasal drip]], [[Pneumonia]], [[Emphysema]], [[Acute bronchitis]], [[Asthma]] }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Wet or [[productive]] cough |B02=[[Cystic fibrosis]], [[Bronchiectasis]], [[Bronchiolitis]], [[Tuberculosis]], [[Rhinitis]], [[Postnasal drip]], [[Pneumonia]], [[Emphysema]], [[Acute bronchitis]], [[Asthma]] }}
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{{familytree | | | | | | | | | |)|-| E01 |-| E02 | | | |E01=[[Barking]] cough |E02=•[[Brassy]] barking: [[Croup]], [[Tracheomalacia]], [[Laryngitis]], [[Tracheitis]] <br>•[[Honking]] barking: [[Psychogenic]] cough , [[Tourette syndrome]] (habit cough) }}
{{familytree | | | | | | | | | |)|-| E01 |-| E02 | | | |E01=[[Barking]] cough |E02=•[[Brassy]] barking: [[Croup]], [[Tracheomalacia]], [[Laryngitis]], [[Tracheitis]] <br>•[[Honking]] barking: [[Psychogenic]] cough , [[Tourette syndrome]] (habit cough) }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| F01 |-| F02 | | | |F01=Phlegmy cough |F02=[[Viral]] infection }}
{{familytree | | | | | | | | | |)|-| F01 |-| F02 | | | |F01=[[Stridor]] |F02=[[Viral]] [[Croup]], [[Epiglottis]], [[Bacterial tracheitis]], [[Retropharyngeal]] and [[peritonsilar]] [[abscess]] }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |`|-| G01 |-| G02 | | | |G01=Burning cough |G02=[[Bacterial Bronchitis]], Irritants }}
{{familytree | | | | | | | | | |`|-| G01 |-| G02 | | | |G01=Burning cough |G02=[[Bacterial Bronchitis]], Irritants }}
Line 94: Line 98:
{{familytree/end}}
{{familytree/end}}


Based on anatomical location the causes of cough in children can be demonstrated into following chart-
Based on anatomical location the causes of cough in children can be demonstrated in the following chart:


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Nose and Paranasal sinuses |A02=[[Rhinitis]], [[Foreign Body]], [[Sinusitis]], [[Nasal polyp]], ppHypertrophied inferior turbinate]] }}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Nose and Paranasal sinuses |A02=[[Rhinitis]], [[Foreign Body]], [[Sinusitis]], [[Nasal polyp]]<nowiki>, ppHypertrophied inferior turbinate]]</nowiki> }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Pharynx |B02=[[Pharyngitis]], [[Foreign Body]], [[Irritants]] }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Pharynx |B02=[[Pharyngitis]], [[Foreign Body]], [[Irritants]] }}
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{{familytree | | | | | | | | | |)|-| G01 |-| G02 | | | |G01=Mediastinum |G02= [[Mediastinitis]], [[Mediastinal Tuberculosis]], [[Thymoma]], [[Thymic hyperplasia]], [[Thymic carcinoma]], [[Neuroblastoma]], [[Ganglioneuroma]], [[Non Hodgkin lymphoma]], [[Sarcoma]], [[Mature teratoma]], [[Endodermal sinus tumor]], [[Hemangioma]], [[Wilms tumor]], [[Lymphangioma]] }}
{{familytree | | | | | | | | | |)|-| G01 |-| G02 | | | |G01=Mediastinum |G02= [[Mediastinitis]], [[Mediastinal Tuberculosis]], [[Thymoma]], [[Thymic hyperplasia]], [[Thymic carcinoma]], [[Neuroblastoma]], [[Ganglioneuroma]], [[Non Hodgkin lymphoma]], [[Sarcoma]], [[Mature teratoma]], [[Endodermal sinus tumor]], [[Hemangioma]], [[Wilms tumor]], [[Lymphangioma]] }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| H01 |-| H02 | | | |H01=Heart and blood vessels |H02=[[Congenital heart disease]], [[Valvular heart disease]], [[Heart failure]], [[Myocarditis]], [[Cardiomyopathies]], [[Wegener granulomatosis]], [[Vasculitis]], [[Arteriovenous malformation]] }}
{{familytree | | | | | | | | | |)|-| H01 |-| H02 | | | |H01=Heart and blood vessels |H02=[[Congenital heart disease]], [[Myocarditis]], [[Heart failure]], [[Cardiomyopathies]], [[Wegener granulomatosis]], [[Valvular heart disease]], [[Vasculitis]], [[Arteriovenous malformation]] }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| I01 |-| I02 | | | |I01=External ear and Tympanic membrane |I02= [[Otitis media]] and externa, [[Impaction of foreign body]], [[wax]], [[Myringitis]] }}
{{familytree | | | | | | | | | |)|-| I01 |-| I02 | | | |I01=External ear and Tympanic membrane |I02= [[Otitis media]] and externa, [[Impaction of foreign body]], [[wax]], [[Myringitis]] }}
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==Differentiating Cough from other Diseases==
==Differentiating Cough from other Diseases==
<small><small>
{|
! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diseases
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="4" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical exam
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Duration
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |PFT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
|-
| rowspan="7" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
| rowspan="7" style="background:#DCDCDC;" align="center" + |[[Upper respiratory tract|'''Upper airway diseases''']]
| style="background:#DCDCDC;" align="center" + |'''[[Epiglottitis|Epiglottitis]]'''<ref name="pmid23162404">{{cite journal |vauthors=Abdallah C |title=Acute epiglottitis: Trends, diagnosis and management |journal=Saudi J Anaesth |volume=6 |issue=3 |pages=279–81 |date=July 2012 |pmid=23162404 |pmc=3498669 |doi=10.4103/1658-354X.101222 |url=}}</ref><ref name="urlEpiglottitis, Acute Laryngitis, and Croup">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120939/ |title=Epiglottitis, Acute Laryngitis, and Croup |format= |work= |accessdate=}}</ref>
| style="background:#F5F5F5;" align="center" + |Abrupt or acute
| style="background:#F5F5F5;" + |
*12−24 hours
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*Ill appearing child in Tripod posture
*[[Inspiratory Stridor]]
*[[Hoarseness]] / Hot-potatoes or [[Muffled]] voice
*[[Drooling]], [[Tachypnea]], [[Tachycardia]]
*[[Cervical lymphadenopathy]], [[Erythematous]] [[pharynx]] and [[larynx]]
| style="background:#F5F5F5;" + |
*Elevated white blood count in CBC
*[[Blood culture]] may show bacterial growth
*Epiglottal culture in intubated patients may show bacterial growth
| style="background:#F5F5F5;" + |
*Enlarge [[epiglottis]] (>8 mm), loss of vallecular air space and distended [[hypopharynx]] as known as 'Thumb print' sign on lateral neck [[X-rays|X−ray]] may be helpful
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Direct visualization of [[Erythema|erythematous]] and edematous [[epiglottis]]
| style="background:#F5F5F5;" + |
*Tripod posture
*[[Drooling]]
*[[Tenderness]] of the anterior part of the neck
*Etiology: ''[[Haemophilus influenzae]]''
|-
| style="background:#DCDCDC;" align="center" + |'''[[Croup|Croup]]'''<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*3−5 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Stridor]]
*[[Rales|Crackles]]
| style="background:#F5F5F5;" + |
*[[Leukopenia]]
| style="background:#F5F5F5;" + |
*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
| style="background:#F5F5F5;" + |
*Decreased [[Lung volumes|tidal volume]]
| style="background:#F5F5F5;" + |
*Clinical diagnosis.
*Laboratory findings and imaging are not necessary for diagnosis
| style="background:#F5F5F5;" + |
*[[Barking cough]]
*Etiology: [[Human parainfluenza viruses|''Parainfluenza'' virus type 1]] (most common)
|-
| style="background:#DCDCDC;" align="center" + |'''[[Pertussis|Pertussis]]'''<ref name="pmid3816065">{{cite journal |vauthors=Bellamy EA, Johnston ID, Wilson AG |title=The chest radiograph in whooping cough |journal=Clin Radiol |volume=38 |issue=1 |pages=39–43 |year=1987 |pmid=3816065 |doi= |url=}}</ref><ref name="urlPertussis | Whooping Cough | Clinical | Information | CDC">{{cite web |url=https://www.cdc.gov/pertussis/clinical/index.html |title=Pertussis &#124; Whooping Cough &#124; Clinical &#124; Information &#124; CDC |format= |work= |accessdate=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*Two weeks
| style="background:#F5F5F5;" align="center" + | + Whooping sound
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*Clear chest
| style="background:#F5F5F5;" + |
*[[Polymerase chain reaction|Polymerase chain reactio]]<nowiki/>n ([[Polymerase chain reaction|PCR]]) shows ''[[Bordetella pertussis]]''
*Serologic testing
| style="background:#F5F5F5;" + |
*[[Atelectasis]] may seen on chest imaging
*[[Lymphadenopathy]]
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Culture
| style="background:#F5F5F5;" + |
*Etiology: ''[[Bordetella pertussis]]''
*Phases: Catarrhal, paroxysmal and convalescent
|-
| style="background:#DCDCDC;" align="center" + |'''[[Common Cold Unit|Common Cold]]'''<ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |year=2005 |pmid=16253889 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*3−10 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" + |
*[[Rales]]
*[[Wheeze|Wheezing]]
| style="background:#F5F5F5;" + |
*Bacterial culture is not indicated
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−Ray]] in patients with signs of [[consolidation]]
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Clinical diagnosis
| style="background:#F5F5F5;" + |
*[[Conjunctival injection]]
*[[Nasal congestion]]
|-
| style="background:#DCDCDC;" align="center" + |[[Tonsilitis]]<ref name="pmid25587367">{{cite journal |vauthors=Stelter K |title=Tonsillitis and sore throat in children |journal=GMS Curr Top Otorhinolaryngol Head Neck Surg |volume=13 |issue= |pages=Doc07 |date=2014 |pmid=25587367 |pmc=4273168 |doi=10.3205/cto000110 |url=}}</ref><ref name="pmid26292396">{{cite journal |vauthors=Bartlett A, Bola S, Williams R |title=Acute tonsillitis and its complications: an overview |journal=J R Nav Med Serv |volume=101 |issue=1 |pages=69–73 |date=2015 |pmid=26292396 |doi= |url=}}</ref><ref name="pmid27981538">{{cite journal |vauthors=Di Muzio F, Barucco M, Guerriero F |title=Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine |journal=Eur Rev Med Pharmacol Sci |volume=20 |issue=23 |pages=4950–4954 |date=December 2016 |pmid=27981538 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute or Acute Recurrent, Chronic
| style="background:#F5F5F5;" + |
*Varies
| style="background:#F5F5F5;" align="center" + | +(Mucus from inflamed tissue)
| style="background:#F5F5F5;" align="center" + |−/+
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |Odynophagia, Tachypnea
| style="background:#F5F5F5;" + |
*[[Stridor]]
*[[Hoarseness of voice]]/ [[Dysphonia]]
*[[Cervical Lymphadenopathy]]
| style="background:#F5F5F5;" + |
*Rapid Antigen Detecting Test
*Throat Swab Culture
*EBV Heterophile Antibody Test
*Monospot Test
*Complete Blood Count
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−Ray]] shows normal finding. USG may show Peritonsillar abscess.
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Rapid Antigen Detecting Test
| style="background:#F5F5F5;" + |
*Etiology: [[Rhinovirus]], [[Adenovirus]], [[Respiratory Syncitial Virus]], [[Influenza Virus]], [[Corona Virus]], [[Group A streptococci]]
|-
| style="background:#DCDCDC;" align="center" + |'''Seasonal [[Influenza (flu)|Influenza]]'''<ref name="pmid27641976">{{cite journal |vauthors=Kumar V |title=Influenza in Children |journal=Indian J Pediatr |volume=84 |issue=2 |pages=139–143 |date=February 2017 |pmid=27641976 |doi=10.1007/s12098-016-2232-x |url=}}</ref><ref name="pmid28346272">{{cite journal |vauthors=Kondrich J, Rosenthal M |title=Influenza in children |journal=Curr Opin Pediatr |volume=29 |issue=3 |pages=297–302 |date=June 2017 |pmid=28346272 |doi=10.1097/MOP.0000000000000495 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*Upper respiratory tract symptoms with fever peaking at three to four days, resolved by seven to ten days.
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +(High grade)
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Fussiness]], [[Vomiting]], [[Diarrhea]], [[Myalgia]],
*[[Focal wheezing]], [[Rales]], [[Tachypnea]], [[Tachycardia]], [[Retractions]], [[Seizures]]
| style="background:#F5F5F5;" + |
*[[Reverse transcription-polymerase chain reaction|RT−PCR]]
*[[Virus culture]]
*[[Rapid Influenza diagnostic test]]
*[[Immunofluroscence]]-Direct or indirect Antibody testing
| style="background:#F5F5F5;" + |
*[[Reticular]] or reticulonodular opacities in [[Chest X-ray|chest X−Ray]]
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Clinical diagnosis
| style="background:#F5F5F5;" + |
*Etiology: A or B [[Influenza virus|''Influenza'' virus]]
|-
| style="background:#DCDCDC;" align="center" + |[[Sinusitis]]<ref name="pmid28042527">{{cite journal |vauthors=Badr DT, Gaffin JM, Phipatanakul W |title=Pediatric Rhinosinusitis |journal=Curr Treat Options Allergy |volume=3 |issue=3 |pages=268–281 |date=September 2016 |pmid=28042527 |pmc=5193235 |doi=10.1007/s40521-016-0096-y |url=}}</ref><ref name="pmid23762621">{{cite journal |vauthors=Shahid SK |title=Rhinosinusitis in children |journal=ISRN Otolaryngol |volume=2012 |issue= |pages=851831 |date=2012 |pmid=23762621 |pmc=3671714 |doi=10.5402/2012/851831 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |[[Acute]], [[Subacute]], [[Chronic]], recurrent
| style="background:#F5F5F5;" + |
*[[Acute]]: < four weeks
*[[Subacute]]: four−twelve weeks
*[[Chronic]]: > twelve weeks
*Recurrent: > four episodes / acute episode of rhinosinusitis yearly.
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*Restlessness, Nasal Congestion, Post Nasal Drip, Facial Pain, Rhinorrhea
| style="background:#F5F5F5;" + |
*In complicated acute [[Rhinosinusitis|bacterial rhinosinusitis]], endoscopic cultures or [[sinus]] aspirate is indicated
*Nasal culture may also be helpful
| style="background:#F5F5F5;" + |
*Air−fluid level, mucosal [[edema]] and bony erosion of sinus on [[Computed tomography|CT]]
*[[Magnetic resonance imaging|MRI]] for distinguish the [[etiology]]
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*Clinical diagnosis: [[Nasal congestion]] and [[Post Nasal drip ]] , [[obstruction]], and purulent [[rhinorrhea]]
| style="background:#F5F5F5;" + |
_
|-
! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diseases
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="4" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical exam
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Duration
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |PFT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
|-
| rowspan="5" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
| rowspan="5" style="background:#DCDCDC;" align="center" + |[[Lower respiratory tract|'''Lower airway''']]
| style="background:#DCDCDC;" align="center" + |'''[[Asthma|Asthma]]'''<ref name="pmid19387030">{{cite journal |vauthors=Gelfand EW |title=Pediatric asthma: a different disease |journal=Proc Am Thorac Soc |volume=6 |issue=3 |pages=278–82 |date=May 2009 |pmid=19387030 |pmc=2677403 |doi=10.1513/pats.200808-090RM |url=}}</ref><ref name="pmid24278725">{{cite journal |vauthors=van Aalderen WM |title=Childhood asthma: diagnosis and treatment |journal=Scientifica (Cairo) |volume=2012 |issue= |pages=674204 |date=2012 |pmid=24278725 |pmc=3820621 |doi=10.6064/2012/674204 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
*Years
| style="background:#F5F5F5;" align="center" + | +  Clear [[Mucoid plaque|mucoid]] or yellow [[sputum]]
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]] (expiratory)
*[[Rales]]
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*[[Eosinophilia]]
*Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]] may be helpful
| style="background:#F5F5F5;" + |
*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  x−ray]]
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
*After physical active [[FEV1]] decreases by >15%
*After inhaled [[corticosteroid]] (ICS)[[FEV1]] increased by >15%
| style="background:#F5F5F5;" + |
*Airflow limitation on [[spirometry]]
| style="background:#F5F5F5;" + |
*Family history
*Seasonal variation
|-
| style="background:#DCDCDC;" align="center" + |[[Bacterial Protracted Bronchitis]]<ref name="pmid32228653">{{cite journal |vauthors=Zhang XB, Wu X, Nong GM |title=Update on protracted bacterial bronchitis in children |journal=Ital J Pediatr |volume=46 |issue=1 |pages=38 |date=March 2020 |pmid=32228653 |pmc=7106696 |doi=10.1186/s13052-020-0802-z |url=}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/patients/patient-resources/resources/pbb-in-children.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
*At least four weeks
| style="background:#F5F5F5;" align="center" + | +(Purulent)
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +/−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Wheezing]]
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*[[Sputum culture]] is not indicated
*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest x−ray]] to exclude other diseases
| style="background:#F5F5F5;" + |
*FEV1 < 80%
| style="background:#F5F5F5;" + |
*Clinical diagnosis
| style="background:#F5F5F5;" + |
*Majority of cases are caused by Streptococci Pneumoniae, Hemophylous Influenza, Staphylococcus aureus
|-
| style="background:#DCDCDC;" align="center" + |'''[[Bronchiectasis|Bronchiectasis]]'''<ref name="pmid28611970">{{cite journal |vauthors=Pizzutto SJ, Hare KM, Upham JW |title=Bronchiectasis in Children: Current Concepts in Immunology and Microbiology |journal=Front Pediatr |volume=5 |issue= |pages=123 |date=2017 |pmid=28611970 |pmc=5447051 |doi=10.3389/fped.2017.00123 |url=}}</ref><ref name="pmid19135586">{{cite journal |vauthors=Redding GJ |title=Bronchiectasis in children |journal=Pediatr Clin North Am |volume=56 |issue=1 |pages=157–71, xi |date=February 2009 |pmid=19135586 |doi=10.1016/j.pcl.2008.10.014 |url=}}</ref><ref name="pmid19213492">{{cite journal |vauthors=Bouyahia O, Essadem L, Matoussi N, Gharsallah L, Fitouri Z, Mrad Mazigh S, Boukthir S, Bellagah I, Ben Becher S, Sammoud El Gharbi A |title=Etiology and outcome of bronchiectasis in children: a study of 41 patients |journal=Tunis Med |volume=86 |issue=11 |pages=996–9 |date=November 2008 |pmid=19213492 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
*Months to years
| style="background:#F5F5F5;" align="center" + | + Mucopurulent [[sputum]]
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Rales|Crackles]]
*[[Wheeze|Wheezing]]
*[[Shortness of breath]]
*[[Chest Pain]]
| style="background:#F5F5F5;" + |
*[[Complete blood count]] ([[Complete blood count|CBC]])
*Sweat Test, CFTR Gene analysis
*Ciliary motility test, Nitric Oxide Test, Ciliary structures, Genetic Testing
*[[Immunoglobulin G|IgG]], [[Immunoglobulin M|IgM]] and [[Immunoglobulin A|IgA]]
*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
| style="background:#F5F5F5;" + |
*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest x−ray]]
*Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio|FEV1/FVC]] <70%
*Normal [[Vital capacity|FVC]]
*Low levels of [[Spirometry|FEV1]]
| style="background:#F5F5F5;" a+ |
*[[Computed tomography|CT]] of chest
| style="background:#F5F5F5;" + |
*[[Digital clubbing]]
*Recurrent [[pleurisy]]
|-
| style="background:#DCDCDC;" align="center" + |'''Foreign body [[Aspiration of foreign body|aspiration]]''<ref name="pmid18345450">{{cite journal |vauthors=Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC |title=Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment |journal=J Bras Pneumol |volume=34 |issue=2 |pages=74–82 |date=February 2008 |pmid=18345450 |doi=10.1590/s1806-37132008000200003 |url=}}</ref><ref name="pmid31217709">{{cite journal |vauthors=Aslan N, Yıldızdaş D, Özden Ö, Yöntem A, Horoz ÖÖ, Kılıç S |title=Evaluation of foreign body aspiration cases in our pediatric intensive care unit: Single-center experience |journal=Turk Pediatri Ars |volume=54 |issue=1 |pages=44–48 |date=2019 |pmid=31217709 |pmc=6559979 |doi=10.14744/TurkPediatriArs.2019.60251 |url=}}</ref><ref name="pmid12736750">{{cite journal |vauthors=Ayed AK, Jafar AM, Owayed A |title=Foreign body aspiration in children: diagnosis and treatment |journal=Pediatr Surg Int |volume=19 |issue=6 |pages=485–8 |date=August 2003 |pmid=12736750 |doi=10.1007/s00383-003-0965-x |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" align="center" + |
*Sudden Onset
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +/-
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +/-
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]], [[Inspiratory]] or [[Biphasic Strioor]]
*Unilateral Decreased [[breath sounds]]
*[[Cyanosis]]
| style="background:#F5F5F5;" + |
*No specific tests
| style="background:#F5F5F5;" + |
*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
*Shift in [[Chest x-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
*[[Computed tomography|CT]] may be helpful
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*[[Bronchoscopy]]
| style="background:#F5F5F5;" + |
*In children <1 year
*Organic materials in children
|-
| style="background:#DCDCDC;" align="center" + |'''[[Bronchiolitis|Bronchiolitis]]'''<ref name="pmid25414585">{{cite journal |vauthors=Friedman JN, Rieder MJ, Walton JM |title=Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age |journal=Paediatr Child Health |volume=19 |issue=9 |pages=485–98 |date=November 2014 |pmid=25414585 |pmc=4235450 |doi=10.1093/pch/19.9.485 |url=}}</ref><ref name="pmid28084708">{{cite journal |vauthors=Smith DK, Seales S, Budzik C |title=Respiratory Syncytial Virus Bronchiolitis in Children |journal=Am Fam Physician |volume=95 |issue=2 |pages=94–99 |date=January 2017 |pmid=28084708 |doi= |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*8−15 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*Rhinorrhoea
*Cyanosis, Hypoxia
*Intercostal and subcostal retraction
*Tachypnea
*[[Wheeze|Wheezing]]
*[[Rales|Crackles]]
*Grunting and Nasal Flaring
| style="background:#F5F5F5;" + |
*[[Complete blood count]] ([[CBC]]) may be helpful
*[[Urinalysis]] & [[urine culture]] ( in infants)
| style="background:#F5F5F5;" + |
*[[Chest X-Ray|Chest x−ray]] may be helpful
| style="background:#F5F5F5;" + |
*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
*Air trapped in [[Lungs]]
*Decreased  [[DLCO|Diffusing capacity of Carbon Monoxide]] ( [[DLCO]])
| style="background:#F5F5F5;" + |
*Clinical diagnosis
| style="background:#F5F5F5;" + |
*Etiology: Respiratory ''[[Human respiratory syncytial virus|syncytial virus]], [[Rhinovirus]]''
*Children <2 years
|-
! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diseases
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="4" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical exam
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Duration
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |PFT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
|-
| rowspan="2" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
| rowspan="2" style="background:#DCDCDC;" align="center" + |[[Lung Parenchyma]]
| style="background:#DCDCDC;" align="center" + |[[Pneumonia]]<ref name="pmid29269189">{{cite journal |vauthors=Katz SE, Williams DJ |title=Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research |journal=Infect Dis Clin North Am |volume=32 |issue=1 |pages=47–63 |date=March 2018 |pmid=29269189 |pmc=5801082 |doi=10.1016/j.idc.2017.11.002 |url=}}</ref><ref name="pmid29237789">{{cite journal |vauthors=Rodrigues CMC, Groves H |title=Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis |journal=J Clin Microbiol |volume=56 |issue=3 |pages= |date=March 2018 |pmid=29237789 |pmc=5824044 |doi=10.1128/JCM.01318-17 |url=}}</ref><ref name="pmid22403224">{{cite journal |vauthors=Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, Bhat N, Murdoch DR, Crawley J, Levine OS, O'Brien KL, Feikin DR |title=The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study |journal=Clin Infect Dis |volume=54 Suppl 2 |issue= |pages=S109–16 |date=April 2012 |pmid=22403224 |pmc=3297550 |doi=10.1093/cid/cir1065 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Rales|Crackles]]
*[[Egophony]]
*Decreased bronchial sounds, Rhonchi
*Rapid Breathing
*Intercostal retractions
*Nasal Flaring, Grunting
*Tachypnea, Tachycardia
*Vomiting
| style="background:#F5F5F5;" + |
*Leftward shift [[leukocytosis]]
*[[Blood culture]] in hospitalized patients
*[[Sputum culture]] in hospitalized patients
| style="background:#F5F5F5;" + |
*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest x−ray]]
*Anatomical changes observed in chest [[Computed tomography|CT]]
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*Infiltration observed in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
*[[Community-acquired pneumonia|Community−acquired pneumonia]]
*[[Healthcare-associated pneumonia|Healthcare−associated pneumonia]]
|-
| style="background:#DCDCDC;" align="center" + |'''[[Tuberculosis]] ([[Tuberculosis|TB]])'''<ref name="pmid28734517">{{cite journal |vauthors=Thomas TA |title=Tuberculosis in Children |journal=Pediatr Clin North Am |volume=64 |issue=4 |pages=893–909 |date=August 2017 |pmid=28734517 |pmc=5555046 |doi=10.1016/j.pcl.2017.03.010 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic<ref name="pmid25037105">{{cite journal |vauthors=Marais BJ, Schaaf HS |title=Tuberculosis in children |journal=Cold Spring Harb Perspect Med |volume=4 |issue=9 |pages=a017855 |date=July 2014 |pmid=25037105 |pmc=4143109 |doi=10.1101/cshperspect.a017855 |url=}}</ref>
| style="background:#F5F5F5;" + |
*Weeks to months
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Pleural effusion]]
*[[Crackles]]
*[[Whispered pectoriloquy]]
*Decreased fremitus
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
*Sputum [[Acid-fast|AFB]] stain may be +.
*[[Mycobacterium Tuberculosis]] [[Culture media|culture]] may be +
*Molecular testing may be helpful
| style="background:#F5F5F5;" + |
*Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
*Decreased [[FEV1]]
*Reduced  [[Vital capacity|FVC]]
| style="background:#F5F5F5;" + |
*Isolation of ''[[Mycobacterium tuberculosis]]''
| style="background:#F5F5F5;" + |
*Etiology: ''[[Mycobacterium tuberculosis]]''
|-
! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diseases
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="4" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical exam
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Duration
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |PFT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
|-
| colspan="2" rowspan="2" style="background:#DCDCDC;" align="center" + |[[Heart|'''Cardiac''']]
| style="background:#DCDCDC;" align="center" + |[[Cardiac Failure]]<ref name="urlCough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK154448/ |title=Cough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid27867456">{{cite journal |vauthors=Jayaprasad N |title=Heart Failure in Children |journal=Heart Views |volume=17 |issue=3 |pages=92–99 |date=2016 |pmid=27867456 |pmc=5105230 |doi=10.4103/1995-705X.192556 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Acute
| style="background:#F5F5F5;" + |
*Hours
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Rales|Crackles]]
*Increased [[respiratory rate]], [[retraction]]
*[[Wheeze|Wheezing]], [[Grunting]], [[Nasal flaring]]
*[[JVD]]
*Displacement of apex beat
*Gallop rhythm, Murmur may present.
*Hepatomegaly, Ascites
| style="background:#F5F5F5;" + |The following investigations may be helpful:
*[[Arterial blood gas]]
*[[Blood urea nitrogen|BUN]]
*[[Serum creatinine|Serum creatinin]]
*Serum [[troponin]]
*[[Electrolyte|Electrolytes]]
*[[Lactic acid]]
*[[Complete blood count]]
| style="background:#F5F5F5;" + |
*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*Clinical diagnosis
*Tests are supportive
| style="background:#F5F5F5;" + |
*[[12-lead ECG|12−lead ECG]]
*Plasma [[Brain natriuretic peptide|BNP]] and [[NT-proBNP|NT−proBNP]]
*[[Echocardiography]]
|-
| style="background:#DCDCDC;" align="center" + |[[Congenital Heart Disease]]
| style="background:#F5F5F5;" align="center" + |Acute or Chronic
| style="background:#F5F5F5;" + |
*Variable
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Crackles]]
*[[Hoarseness]]
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*[[Electrocardiogram]] may be helpful
*Enlargement of [[left atrium]] and [[appendage]] in [[Chest X-ray|chest radiograph]]
| style="background:#F5F5F5;" + |
*[[Vital capacity|FVC]] reduced
| style="background:#F5F5F5;" + |
*Resting [[transthoracic echocardiography]]
| style="background:#F5F5F5;" + |
*[[Stress testing]]
*[[Cardiac catheterization]]
|-
! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diseases
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="4" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other features
|-
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical exam
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Onset
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Duration
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" + |PFT
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
|-
| colspan="2" style="background:#DCDCDC;" align="center" + |[[Gastrointestinal tract|'''Gastrointestinal''']]
| style="background:#DCDCDC;" align="center" + |[[Gastroesophageal reflux disease|'''Gastroesophageal reflux''']]<ref name="pmid11683086">{{cite journal |vauthors=Juchet A, Brémont F, Dutau G, Olives JP |title=[Chronic cough and gastroesophageal reflux in children] |language=French |journal=Arch Pediatr |volume=8 Suppl 3 |issue= |pages=629–634 |date=August 2001 |pmid=11683086 |doi=10.1016/s0929-693x(01)80018-x |url=}}</ref><ref name="pmid16504152">{{cite journal |vauthors=Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, Withers GD, Patrick MK, Lewindon PJ |title=Cough and reflux esophagitis in children: their co-existence and airway cellularity |journal=BMC Pediatr |volume=6 |issue= |pages=4 |date=February 2006 |pmid=16504152 |pmc=1409774 |doi=10.1186/1471-2431-6-4 |url=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
*Variable
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" + |
*[[Wheeze|Wheezing]]
*[[Hoarseness]]
*Regurgitation, Vomiting
*Back Arching, crying
*Apnea
*Epigastric pain
| style="background:#F5F5F5;" + |
*Not specific
| style="background:#F5F5F5;" + |
*[[Upper endoscopy]] may be helpful
*[[Barium]] esophagram may be helpful
| style="background:#F5F5F5;" + |
*Normal function
| style="background:#F5F5F5;" + |
*PH testing
| style="background:#F5F5F5;" align="center" + |−−
|}
</small></small>


==Epidemiology and Demographics==
==Epidemiology and Demographics==


*Cough is one of the most common symptoms of children in outpatient department.
*A [[cough]] is one of the most common [[presenting]] [[symptoms]] of [[children]] in the [[Outpatient|outpatient department]].
*Ninety percent of acute cough in children is resolved within three weeks. The prevalence of Chronic Cough in children is approximately 5% to 10% in USA according to American Academy of Pediatrics.
*Ninety percent of [[acute cough]]s in children are resolved within three weeks. The [[prevalence]] of [[Chronic cough|chronic cough]] in [[children]] is approximately 5% to 10% in the [[United States|USA]] according to the [[American Academy of Pediatrics]].
   
   
===Age===
===Age===
   
   
*Cough is more commonly observed among children under 5 years of age.<ref name="pmid16428719">{{cite journal |vauthors=Chang AB, Glomb WB |title=Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=260S–283S |date=January 2006 |pmid=16428719 |doi=10.1378/chest.129.1_suppl.260S |url=}}</ref>
*[[Cough]] is more commonly observed among [[children]] under 5 years of age.<ref name="pmid16428719">{{cite journal |vauthors=Chang AB, Glomb WB |title=Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=260S–283S |date=January 2006 |pmid=16428719 |doi=10.1378/chest.129.1_suppl.260S |url=}}</ref>
   
   
===Gender===
===Gender===


*Boys are more commonly affected with cough than girls.<ref name="urlPrevalence of cough throughout childhood: A cohort study">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177485 |title=Prevalence of cough throughout childhood: A cohort study |format= |work= |accessdate=}}</ref>
*Boys are more commonly affected with [[cough]] than girls.<ref name="urlPrevalence of cough throughout childhood: A cohort study">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177485 |title=Prevalence of cough throughout childhood: A cohort study |format= |work= |accessdate=}}</ref>


===Race===
===Race===


*There are racial predilection for certain causes of Cough in children. Asthma is predominant in Blacks and American Indians or Alaska native while Cystic fibrosis, Wegener's granulomatosis are more frequently affecting Caucasians according to American Lung Association.
*There are [[racial]] predispositions for certain causes of [[cough in children]]. [[Asthma]] is predominant in Blacks and American Indians or Alaska natives while [[Cystic fibrosis]], [[Wegener's granulomatosis]] more frequently affect Caucasians according to the [[American Lung Association]].


==Risk Factors==
==Risk Factors==
 
*Common [[risk factors]] in the [[development]] of a cough in children are:<ref name="pmid16428686">{{cite journal |vauthors=Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UBS, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM |title=Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=1S–23S |date=January 2006 |pmid=16428686 |pmc=3345522 |doi=10.1378/chest.129.1_suppl.1S |url=}}</ref><ref name="pmid4806394">{{cite journal |vauthors=Hope-Simpson RE, Miller DL |title=The definition of acute respiratory illnesses in general practice |journal=Postgrad Med J |volume=49 |issue=577 |pages=763–70 |date=November 1973 |pmid=4806394 |pmc=2495832 |doi=10.1136/pgmj.49.577.763 |url=}}</ref>
*Common risk factors in the development of Cough in children are-
**[[Preterm birth|Preterm]] birth and delivery by [[caesarian section]].
**Preterm Birth and delivery by caesarian section.
**[[Respiratory Distress Syndrome]].
**Respiratory Distress Syndrome.
**[[Congenital Heart Disease]].
**Congenital Heart Disease.
**Age less than 1 year.
**Age less than 1 year.
**Maternal Influenza vaccination.
**[[Maternal]] [[Influenza vaccination]].
**Malnutrition.
**[[Malnutrition]].
**Secondary exposure to tobacco smoke.
**[[Secondary|Secondary exposure]] to [[tobacco smoke]].
**Air pollutants, Mold, Inadequate ventilation.
**Air pollutants, [[Mold]], Inadequate [[ventilation]].
**Immunodeficiencies.
**[[Immunodeficiency|Immunodeficiencies]].
**Daycare attendance.
**Daycare attendance.
**History of Atopy.
**History of [[Atopy]].
**Household pets.
**Household pets.
**Low socioeconomic status.
**Low [[socioeconomic]] status.


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==


*The majority of patients with acute cough have recovery within three weeks in 90% of cases. Some of cases are progressed to sub-acute and chronic phases. Chronic cough lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.
*The majority of patients with [[acute cough]] have recovery within three weeks in 90% of cases. Some cases are progressed to [[subacute]] and [[chronic]] phases. [[Chronic cough]] lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.<ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
*Early clinical features include frequent episodes of coughing, Runny nose, Sneezing, Low grade fever, Sore Throat, Night Sweats, Arching Back, Irritability, Failure to thrive, Fussiness, Chocking sensation(Foreign body impaction).
*Early clinical features include frequent episodes of [[coughing]], [[runny nose]], [[sneezing]], [[low grade fever]], [[sore throat]], [[night sweats]], arching back, [[irritability]], [[failure to thrive]], [[fussiness]], and a choking sensation(foreign body impaction).<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref>
*If left untreated, Cough can cause following complication in children.
*If left untreated, acute cough can cause following the [[Complications|complication]]s in children:<ref name="urlAcute cough in children">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056681/ |title=Acute cough in children |format= |work= |accessdate=}}</ref><ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
**[[Otitis Media]]
**[[Rash]]
**[[Vomiting]]
**[[Diarrhea]]
**[[Bronchitis]]
**[[Pneumonia]]
*Chronic cough can progress to<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>-
**Inability to sleep
**[[Bronchospasm]]
**[[Dizziness]]/ [[Syncope]]
**[[Pneumothorax]]
**[[Pneumomediastinum]]
*[[Rib fracture]]


*Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].
*[[Prognosis]] is generally excellent and efficiently treatable in most of the etiology of cough in children.


==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
 
*Diagnosis of causes of a cough is made after a detailed history, [[Presenting symptom|presenting]] complaints and [[physical examination]] and laboratory findings in some cases. Cough can be classified according to:<ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
*The diagnosis of Causes of Cough is made after a detailed history, presenting complaints and physical examination and laboratory findings in some cases. Cough can be classified according to-
**Duration.
**Duration.
**Nature or quality of cough.
**Nature or quality of cough.
Line 172: Line 795:
**Anatomic location.
**Anatomic location.
**Grade.
**Grade.
A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, aleviating factors, amount work of breathing, presence of shortness of breathing, relation with vomiting, food intake, posture, presence of blood, systemic findings(fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of chocking, houshold socioeconomic status, family history, drug abuse and smoking in family members, atopy, congenital history.
 
The following sighns are alarming which need further emergent evaluation by the physician.
A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with [[vomiting]], food intake, [[posture]], presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.
:*[Cyanosis or hypoxemia or hypoxia]
 
:*[Respiratory distress]
The following signs are alarming which need further emergent evaluation by the physician:
:*[Stridor]
 
:*[Toxic appearence]
:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
:*[Weight loss]
:*[[Respiratory distress]]
:*[[Stridor]]
:*[[Toxic appearance]]
:*[[Weight loss]]


===Symptoms===
===Symptoms===


*Symptoms of Cough may include the following:
*Cough may be associated with the following depending upon the cause:
 
:*[[Breathlessness]] and episodes of [[coughing]]
:*[[Sneezing]]
:*[[Fever]]
:*[[Sore Throat]]
:*[[Night Sweats]]
:*[[Arching Back]]
:*[[Irritability]]
:*[[Failure to thrive]]
:*[[Fussiness]]
:*[[Choking sensation]]([[Foreign body]] impaction)
:*[[Chills and Rigor]]
:*[[Wheezing]]
:*[[Headache]], [[myalgia]], [[fatigue]]


:*[Breathelessness and episodes of coughing]
:*[Runny nose]
:*[Sneezing]
:*[Fever]
:*[Sore Throat]
:*[Night Sweats]
:*[Arching Back]
:*[Irritability]
:*[Failure to thrive]
:*[Fussiness]
:*[Chocking sensation(Foreign body impaction)]
:*[Chills and Rigor]
:*[Wheezing]
:*[Headache, myalgia, fatigue]
       
===Physical Examination===
===Physical Examination===


*Patients with [disease name] usually appear [general appearance].
*Patients with [[cough]] are usually restless, [[irritable]], fussy. Children with severe [[respiratory distress]] usually are [[toxic]] and [[cyanotic]] in appearance. Presence of [[grunting]], nasal flaring, [[intercostal]] or [[subcostal]] [[retraction]] or [[accessory muscles of respiration|accessory muscle]] usage needs prompt evaluation.<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref><ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
*Physical examination may be remarkable for:
*Physical examination may be remarkable for:


:*[finding 1]
*Vital signs: Documentation according to patient's [[age]]
:*[finding 2]
**[[Blood pressure]]
:*[finding 3]
**[[Temperature]]
:*[finding 4]
**[[Respiratory rate]]
:*[finding 5]
**[[Heart rate]]
:*[finding 6]
 
**[[Growth]] charts and [[Human development (biology)|developmental]] milestones: [[weight]], [[height]], [[length]], occipitofrontal circumference
*General Appearance: Level of [[consciousness]], [[Cyanosis]], Distressed or ill-appearing, hydration and nutritional status.
*[[Skin]]: [[Turgor]], [[color]], texture, [[Rash|rashes]] or any other abnormal findings.
*[[Lymphatics]]: [[Lymphadenopathy]], location, number and size, consistency, adherence to underlying structures.
*[[Head]]: Size, shape, [[Fontanelle|fontanelle,]] overlapping [[suture]], [[scalp]], [[hair]].
*[[Eyes]]: [[Lacrimation]], [[redness]], [[irritation]],  [[conjunctival injection]], [[Periorbital Edema|periorbital]] redness.
*[[Ears]]: Position of ears along with [[external auditory canal]], [[tympanic membrane]] visualization.
*[[Nose]]: Any deviation of [[nasal septum]], normal or hypertrophied inferior [[Nasal concha|turbinate]], [[nasal polyps]] and [[congestion]], [[nasal discharge]], tenderness over [[sinus]] point.
*[[Mouth]] and [[throat]]: Look for any associated abnormality
**[[Lips]]: [[Color]], [[Mucous membrane|mucosal]] abnormality and [[congenital]] lesions.
**[[Buccal mucosa]]: Hydration, Color, Presence of anomaly.
**[[Tongue]] and [[teeth]] and [[Gingiva|gum]]: Developmental anomaly, Color, [[papillae]].
**[[Palate]]: [[Anomaly]], arch.
**[[Tonsils]]: Color, size, any [[membrane]], [[calcification]] and exudates.
**Posterior pharyngeal wall: Color, appearance.
**[[Gag reflex]]: Intact or not.
*[[Neck]]: [[Thyroid]], [[trachea]] position and examination, any [[cystic]] or [[nodular]] masses, presence of [[nuchal rigidity]].
*[[Respiratory system|Respiratory]]:
**[[Inspection (medicine)|Inspection]]: Breathing pattern (abdominal and periodic), respiratory rate, accessory muscle usage, chest wall shape.
**[[Auscultation]]: breath sound symmetry, [[vesicular]], [[bronchial]], [[rales]], [[rhonchi]], wheezes, [[stridor]].
**[[Percussion]]: [[resonance]], hyper resonance and dull.
**[[Palpation]]: [[trachea]] position, [[tactile fremitus]].
*[[Cardiovascular]]: [[rhythm]], [[heart murmur|murmur]], any radiation of sound, [[pulse]] in both extremities.
*[[Gastrointestinal tract|Gastrointestinal]]: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses or rebound guarding.
*[[Musculoskeletal system|Musculoskeletal]]: Aching back, [[scoliosis]], [[lordosis]], [[kyphoscoliosis]], swelling and tenderness in any muscles, joint, [[clubbing]], [[edema]], deformity of extremities, [[gait]] and [[posture]], any sign for [[hip dysplasia]].
*[[CNS]]: [[Primitive reflexes|Primitive reflex,]] superficial and deep [[tendon reflex]], strength and tone of muscles, [[Cranial nerves|cranial nerve]] examination.
*[[Genitourinary system|Genitourinary]]: Presence of [[external genitalia]] deformity , [[hydrocele]], [[cryptorchidism]] or [[hernia]].


===Laboratory Findings===
===Laboratory Findings===


*There are no specific laboratory findings associated with [disease name].
*There are no specific [[Laboratory findings template|laboratory findings]] associated with cough. [[Laboratory test]]s are done to differentiate the causes of cough in children<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>.
 
*[[Complete blood count|Complete Blood Count]]
*[positive/negative] [test name] is diagnostic of [disease name].
*[[Arterial blood gases|Arterial blood gas analysis]]
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*[[Culture medium|Culture]] of nasopharyngeal swab and broncho alveolar lavage
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
*[[Gross examination|Gross]] and [[Microscopic examination|microscopic]] analysis and [[Sputum culture|culture of sputum]]
*[[AFB stain|AFB]] testing and [[tuberculosis]] screening
*[[Allergy]] test
*Serum [[Immunoglobulins]], [[autoantibodies]]
*[[Sweat test]]
*Exhaled [[nitric oxide]] test
*[[Esophageal|Esophagea]]<nowiki/>l [[pH]]
*Serology for Pertusis, CMV, Chlamydia, HIV.


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
An [[The electrocardiogram|ECG]] may not be helpful in the diagnosis of [[congenital heart disease]], [[myocarditis]], [[valvular heart disease]], in children.
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: [[Pneumonia]], [[Croup]], [[Bronchitis]], [[Epiglottitis]], [[Foreign body]] impaction etc. [[X-rays|X-ray]] of [[Paranasal sinus|paranasal sinuses]] helps in diagnosis of [[sinusitis]], deviated nasal septum.
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound findings associated with [disease name].
[[Echocardiography]]/[[ultrasound]] may be helpful in the diagnosis of causes of [[cough in children]]. [[Echocardiography|Echocardiographic]] findings aide in the diagnosis of [[congenital heart disease]], whereas USG findings can help in evaluating complications like [[peritonsillar abscess]], [[retropharyngeal abscess]] promptly.
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
The [[High Resolution CT|High resolution CT]] is used for diagnosing causes of [[chronic cough]] in children such as [[bronchiectasis]]. Sometimes it helps in identifying [[Congenital heart disease|congenital heart]] and [[Lung|lung anomalie]]<nowiki/>s.
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
A [[Chest]] [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of the dynamic function of airways disease.<ref name="pmid26342643">{{cite journal |vauthors=Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH |title=Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging |journal=Pediatr Radiol |volume=45 |issue=13 |pages=1901–15 |date=December 2015 |pmid=26342643 |pmc=4666905 |doi=10.1007/s00247-015-3420-y |url=}}</ref>. MRI can provide detailed findings of [[perfusion]], [[ventilation]] mechanism of [[lungs]] and [[diaphragm]]. It can show oxygen enhancement, congenital anomalies too.
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
Other [[imaging]] techniques are used to evaluate causes of [[cough in children]].


OR
*Flexible [[Bronchoscopy]]
*[[Barium]] esophagram.
*[[Angiography]]


[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
===Other Diagnostic Studies===


===Other Diagnostic Studies===
Other investigations done to rule out [[differential diagnosis]] of [[cough in children]] are:


*[Disease name] may also be diagnosed using [diagnostic study name].
*[[Spirometry]] for evaluating [[Pulmonary function test|pulmonary function test.]]
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
*[[Bronchodilators|Bronchodilator]] [[Provocation study|provocatio]]<nowiki/>n test.
*Ciliary function test.
*[[Genetic analysis]] for [[Cystic fibrosis transmembrane conductance regulator|CFTR]] [[mutation]], [[Primary ciliary dyskinesia]] etc.
*Video [[fluoroscopic]] or [[Endoscopic|endoscopic swallow]] evaluation.
*Environmental assessment.


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===


*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action 1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
   
   
*The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in the following sequences:<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |pmc=6372369 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref><ref name="pmid23115499">{{cite journal |vauthors=Goldman RD |title=Treating cough and cold: Guidance for caregivers of children and youth |journal=Paediatr Child Health |volume=16 |issue=9 |pages=564–9 |date=November 2011 |pmid=23115499 |pmc=3223897 |doi=10.1093/pch/16.9.564 |url=}}</ref><ref name="urlGuidelines for Evaluating Chronic Cough in Pediatrics CHEST">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(15)52858-4/fulltext#seccestitle90 |title=Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST |format= |work= |accessdate=}}</ref><ref name="pmid30828592">{{cite journal |vauthors=Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ |title=Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough |journal=Glob Pediatr Health |volume=6 |issue= |pages=2333794X19831296 |date=2019 |pmid=30828592 |pmc=6390215 |doi=10.1177/2333794X19831296 |url=}}</ref>
*Identification of etiology of cough and emergently manage the emergency condition such as [[foreign body impaction]], severe respiratory distress, [[apnea]] with maintenance of airways, breathing, circulation.
*General measures with adequate hydration, nasal airway clearance with normal saline, reducing fever with [[antipyretics]] are done to give comfort to the child.
*Medical management:
**[[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
**[[Bronchodilators]] ([[Ipratropium bromide]], [[Albuterol]], [[Salmeterol]], [[Salbutamol]]), [[Antibiotic]] ([[Amoxicillin-Clavulanate|Amoxicillin/Clavulanate]], [[Cephalosporins]], [[Respiratory]] [[fluoroquinolones]], [[Antiviral]], [[Antifungal]], [[Antiparasitic]]) are used according to [[Evidence-based medicine|evidence-based management]] of particular causes of cough in children.
===Surgery===
===Surgery===


*Surgery is the mainstay of therapy for [disease name].
*Some [[surgical procedure]]s are performed for patients with [[Tonsillitis]], [[Adenoid hypertrophy|adenoid hypertroph]]<nowiki/>y, severe cases of [[laryngomalacia]], [[tracheoesophageal fistula]], [[congenital heart disease]], [[complications]] of any disease or trauma in [[ear]], [[nose]], [[Paranasal sinus|sinuses]], [[pharynx]], [[larynx]], [[trachea]], [[bronchus]], [[Lung|lungs]], and [[ribs]].
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
   
   
===Prevention===
===Prevention===


*There are no primary preventive measures available for [disease name].
*Effective measures for the [[primary prevention]] of cough include:
**Caregivers should be given [[health education]] on pros and cons of [[vaccination]], alarming features of cough.
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
**Physical [[hygiene]] including [[airways]] of an infant or a child should be maintained to prevent complications.
 
**Head should be raised to prevent irritations in [[throat]].
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
**Humidified air will help clearing the sputum easily.
**Adequate [[hydration]] to prevent formation of [[dry sputum]].
**Avoidance of triggers in case of [[atopic]] patient.
**[[Nutritional]] balance should be maintained for rebooting the [[immunity]].


==References==
==References==
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[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]
[[Category:Up-To-Date]]

Latest revision as of 21:03, 24 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Synonyms and keywords: Cough in kids

Overview

Cough is a common complaint of the pediatric population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of respiratory airways. The word 'Cough' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, anatomical location, etiology and grades of coughs. Stimulation to cough receptors provokes sensations of coughing through the afferent pathway via the vagus nerve, central respiratory centers in the upper pons and medulla, and efferent pathways via the phrenic and vagus branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of physical examination, laboratory, and imaging investigations. Some of the causes are emergently managed to reduce the mortality of a child.The mainstay of therapy for cough is supportive. Antihistamine, antitussive medications and nasal decongestant are provided for alleviating symptoms of acute cough. Allergic conditions are treated with steroids.

Historical Perspective

  • The word cough was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.

Classification

  • Cough in children may be classified or defined according to the duration of presenting complaints, quality and sound, and causes of cough into several groups.[1]:
  • 1 Duration of Presenting complaints: According to the duration of cough, it can be sub-classified into three categories:
  • 2. Nature or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
    • Dry or Hacking or Nonproductive.
    • Wet or productive cough.
    • Staccato or short repetitive cough.
    • Whooping or paroxysmal violent or spasmodic cough.
    • Barking cough: Brassy barking or Honking barking.
    • Phlegmy cough.
    • Burning cough.
  • 3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
    • Specific cough.
    • Nonspecific cough.
    • Expected cough or Normal cough.
  • 5. Grades of cough: Cough can be graded into four main sub categories:[2]
    • Eutussia or Normal.
    • Hypertussia or Sensitized.
    • Hypotussia or Desensitized.
    • Dystussia or Pathological.
    • Atussia or Absent.

Cough in children can also be classified under infectious (Bacterial, Viral, fungal, Parasitic) or non-infectious categories broadly.

Pathophysiology

 
 
 
Mechanical and chemical stimulation of cough receptors (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in Respiratory airways
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Afferent pathways: Sensory nerve fibers via Vagus Nerve from ciliated columnar epithelium of upper airways, cardiac and esophageal branches from diaphragm send impulse to central cough center
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Central cough center in upper brain stem medulla and pons send impulse of sequence of phases (Inspiratory, Compressive, Expiratory) for constituting cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Efferent pathways: The nucleus retroambigualis sends impulse via phrenic and spinal motor nerves to diaphragm and abdominal and respiratory muscles, the nucleus ambiguous sends impulse to larynx by laryngeal branches of vagus nerve
 
 
 

Causes

Causes of cough in children according to duration[4][5][6]:

 
 
 
 
 
 
 
 
Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute(<3 weeks) •Common Cold
Allergic Rhinitis
Bronchitis
Bronchiolitis
Asthma
Whooping Cough
Influenza
Croup or Tracheolaryngobronchitis
Pneumonia
Irritation by smoking
Foreign Body
GERD
 
 
 
 
Subacute(3-8 weeks) •Whooping Cough or Pertussis
•Post infectious Cough
Bacterial Sinusitis
Asthma
 
 
 
 
Chronic(>8 weeks) •Upper Airway Cough Syndrome
Asthma
Bronchiectasis in Cystic fibrosis and Kartagener Syndrome
Chronic sinusitis
Malacia
•Foreign Body
Nonasthmatic eosinophilic bronchitis
•Respiratory environmental toxins

According to quality and sound of cough in children, the causes can be classified according to the following chart:

 
 
 
 
 
 
 
 
 
 
 
 
Dry or Hacking or Nonproductive
 
Sinusitis, Tonsillitis, Pharyngitis, Allergic Rhinitis, GERD, Asthma, Environmental exposure to irritants(pollen, dust, mites, smoke), Post infectious cough.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wet or productive cough
 
Cystic fibrosis, Bronchiectasis, Bronchiolitis, Tuberculosis, Rhinitis, Postnasal drip, Pneumonia, Emphysema, Acute bronchitis, Asthma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes of Cough based on Nature or quality and sound
 
 
 
 
Staccato or short repetitive cough
 
Chlamydia pneumonia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Whooping or paroxysmal violent or spasmodic cough
 
Pertussis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Barking cough
 
Brassy barking: Croup, Tracheomalacia, Laryngitis, Tracheitis
Honking barking: Psychogenic cough , Tourette syndrome (habit cough)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stridor
 
Viral Croup, Epiglottis, Bacterial tracheitis, Retropharyngeal and peritonsilar abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Burning cough
 
Bacterial Bronchitis, Irritants
 
 
 
 
 
 

Based on anatomical location the causes of cough in children can be demonstrated in the following chart:

 
 
 
 
 
 
 
 
 
 
 
 
Nose and Paranasal sinuses
 
Rhinitis, Foreign Body, Sinusitis, Nasal polyp, ppHypertrophied inferior turbinate]]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pharynx
 
Pharyngitis, Foreign Body, Irritants
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Larynx
 
Laryngitis, Epiglottis, Tonsillitis, Laryngomalacia, Subglottic stenosis, Foreign body
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trachea and Bronchi
 
Tracheitis, Croup, Bronchiolitis, Bronchiectasis, Bronchitis, Cystic fibrosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes based on anatomic location
 
 
 
 
Pulmonary parenchyma
 
Pneumonia, Tuberculosis, Environmental toxin, Respiratory distress syndrome, Aspiration syndrome, Hypersensitivity Pneumonitis, Connective tissue disease, Alveolar capillary dysplasia, Neuroendocrine cell hyperplasia of infancy, Medications, Mutations causing surfactant dysfunction, Emphysema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pleura
 
Pleurisy, Pneumothorax, Hemothorax, Parapneumonic effusions, Pleural tuberculosis, Congenital hydrothorax and chylothorax
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mediastinum
 
Mediastinitis, Mediastinal Tuberculosis, Thymoma, Thymic hyperplasia, Thymic carcinoma, Neuroblastoma, Ganglioneuroma, Non Hodgkin lymphoma, Sarcoma, Mature teratoma, Endodermal sinus tumor, Hemangioma, Wilms tumor, Lymphangioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Heart and blood vessels
 
Congenital heart disease, Myocarditis, Heart failure, Cardiomyopathies, Wegener granulomatosis, Valvular heart disease, Vasculitis, Arteriovenous malformation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
External ear and Tympanic membrane
 
Otitis media and externa, Impaction of foreign body, wax, Myringitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Esophagus
 
GERD, Tracheoesophageal Fistula
 
 
 
 
 
 

Differentiating Cough from other Diseases

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Epiglottitis[7][8] Abrupt or acute
  • 12−24 hours
+ +
  • Elevated white blood count in CBC
  • Blood culture may show bacterial growth
  • Epiglottal culture in intubated patients may show bacterial growth
  • Enlarge epiglottis (>8 mm), loss of vallecular air space and distended hypopharynx as known as 'Thumb print' sign on lateral neck X−ray may be helpful
  • Normal function
Croup[9] Acute
  • 3−5 days
+ + +
  • Clinical diagnosis.
  • Laboratory findings and imaging are not necessary for diagnosis
Pertussis[10][11] Acute
  • Two weeks
+ Whooping sound + + +
  • Clear chest
  • Normal function
  • Culture
Common Cold[12] Acute
  • 3−10 days
+ +
  • Bacterial culture is not indicated
  • Normal function
  • Clinical diagnosis
Tonsilitis[13][14][15] Acute or Acute Recurrent, Chronic
  • Varies
+(Mucus from inflamed tissue) −/+ + Odynophagia, Tachypnea
  • Rapid Antigen Detecting Test
  • Throat Swab Culture
  • EBV Heterophile Antibody Test
  • Monospot Test
  • Complete Blood Count
  • Chest X−Ray shows normal finding. USG may show Peritonsillar abscess.
  • Normal function
  • Rapid Antigen Detecting Test
Seasonal Influenza[16][17] Acute
  • Upper respiratory tract symptoms with fever peaking at three to four days, resolved by seven to ten days.
+(High grade) +
  • Normal function
  • Clinical diagnosis
Sinusitis[18][19] Acute, Subacute, Chronic, recurrent
  • Acute: < four weeks
  • Subacute: four−twelve weeks
  • Chronic: > twelve weeks
  • Recurrent: > four episodes / acute episode of rhinosinusitis yearly.
+ + +
  • Restlessness, Nasal Congestion, Post Nasal Drip, Facial Pain, Rhinorrhea
  • Air−fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function

_

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical findings Lab findings Imaging PFT Gold standard
Respiratory Lower airway Asthma[20][21] Chronic
  • Years
+ Clear mucoid or yellow sputum +
  • Family history
  • Seasonal variation
Bacterial Protracted Bronchitis[22][23] Chronic
  • At least four weeks
+(Purulent) + +/− +
  • FEV1 < 80%
  • Clinical diagnosis
  • Majority of cases are caused by Streptococci Pneumoniae, Hemophylous Influenza, Staphylococcus aureus
Bronchiectasis[24][25][26] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
'Foreign body aspiration[27][28][29] Acute
  • Sudden Onset
+ +/- +/- +
  • No specific tests
  • Not specific
  • In children <1 year
  • Organic materials in children
Bronchiolitis[30][31] Acute
  • 8−15 days
+ + +
  • Rhinorrhoea
  • Cyanosis, Hypoxia
  • Intercostal and subcostal retraction
  • Tachypnea
  • Wheezing
  • Crackles
  • Grunting and Nasal Flaring
  • Clinical diagnosis
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Respiratory Lung Parenchyma Pneumonia[32][33][34] Acute + + +
  • Crackles
  • Egophony
  • Decreased bronchial sounds, Rhonchi
  • Rapid Breathing
  • Intercostal retractions
  • Nasal Flaring, Grunting
  • Tachypnea, Tachycardia
  • Vomiting
  • Not specific
Tuberculosis (TB)[35] Chronic[36]
  • Weeks to months
+ + + + +
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Cardiac Cardiac Failure[37][38] Acute
  • Hours
+ + The following investigations may be helpful:
  • Not specific
  • Clinical diagnosis
  • Tests are supportive
Congenital Heart Disease Acute or Chronic
  • Variable
+ + +
  • Not specific
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Gastrointestinal Gastroesophageal reflux[39][40] Chronic
  • Variable
+ + +
*Apnea
  • Epigastric pain
  • Not specific
  • Normal function
  • PH testing
−−

Epidemiology and Demographics

Age

Gender

  • Boys are more commonly affected with cough than girls.[42]

Race

Risk Factors

Natural History, Complications and Prognosis

  • Prognosis is generally excellent and efficiently treatable in most of the etiology of cough in children.

Diagnosis

Diagnostic Criteria

  • Diagnosis of causes of a cough is made after a detailed history, presenting complaints and physical examination and laboratory findings in some cases. Cough can be classified according to:[48]
    • Duration.
    • Nature or quality of cough.
    • Etiology.
    • Anatomic location.
    • Grade.

A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with vomiting, food intake, posture, presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.

The following signs are alarming which need further emergent evaluation by the physician:

Symptoms

  • Cough may be associated with the following depending upon the cause:

Physical Examination

Laboratory Findings

Electrocardiogram

An ECG may not be helpful in the diagnosis of congenital heart disease, myocarditis, valvular heart disease, in children.

X-ray

Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: Pneumonia, Croup, Bronchitis, Epiglottitis, Foreign body impaction etc. X-ray of paranasal sinuses helps in diagnosis of sinusitis, deviated nasal septum.

Echocardiography or Ultrasound

Echocardiography/ultrasound may be helpful in the diagnosis of causes of cough in children. Echocardiographic findings aide in the diagnosis of congenital heart disease, whereas USG findings can help in evaluating complications like peritonsillar abscess, retropharyngeal abscess promptly.

CT scan

The High resolution CT is used for diagnosing causes of chronic cough in children such as bronchiectasis. Sometimes it helps in identifying congenital heart and lung anomalies.

MRI

A Chest MRI may be helpful in the diagnosis of the dynamic function of airways disease.[49]. MRI can provide detailed findings of perfusion, ventilation mechanism of lungs and diaphragm. It can show oxygen enhancement, congenital anomalies too.

Other Imaging Findings

Other imaging techniques are used to evaluate causes of cough in children.

Other Diagnostic Studies

Other investigations done to rule out differential diagnosis of cough in children are:

Treatment

Medical Therapy

Surgery

Prevention

  • Effective measures for the primary prevention of cough include:
    • Caregivers should be given health education on pros and cons of vaccination, alarming features of cough.
    • Physical hygiene including airways of an infant or a child should be maintained to prevent complications.
    • Head should be raised to prevent irritations in throat.
    • Humidified air will help clearing the sputum easily.
    • Adequate hydration to prevent formation of dry sputum.
    • Avoidance of triggers in case of atopic patient.
    • Nutritional balance should be maintained for rebooting the immunity.

References

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