Cough in children: Difference between revisions

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==Overview==
==Overview==
[[Cough]] is a common presenting complaints of [[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 dynamic mechanism of [[respiratory]] airways. The word [[Cough|'Cough]]' is rooted to 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For Example, duration of presenting complaints, nature or quality, [[anatomical]] location, [[etiology]] and grades of coughs. Stimulation to cough [[receptors]] provokes sensations of coughing through [[afferent]] pathway via [[vagus nerve]], central respiratory centers in upper [[pons]] and [[medulla]], and [[efferent]] pathways via [[phrenic]] and [[vagus]] branches. Differential diagnosis 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.
[[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 symptom|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>:
*[[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>:
*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub classified into three categories.
*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub-classified into three categories:
**[[Acute]]: Cough persists for less than three weeks.
**[[Acute]]: < 3 weeks.
**[[Subacute]]: Cough persists for three to eight weeks.
**[[Subacute]]: 3 to 8 weeks.
**[[Chronic]]: Cough persists for more than eight weeks.
**[[Chronic]]: > 8 weeks.


*2. [[Nature]] or Quality and sounds: According to the quality and sound cough can be sub classified in to following categories-
*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.
**[[Dry Cough|Dry]] or Hacking or Nonproductive.
**Wet or [[productive cough]].
**Wet or [[productive cough]].
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**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 sinus|Paranasal]] sinuses.
**[[Nose]] and [[Paranasal sinus|Paranasal]] sinuses.
**[[Pharynx]].
**[[Pharynx]].
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**[[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|Viral,]] [[fungal]], [[Parasitic]]) or non-infectious 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 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 defensive mechanism protecting [[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>
*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/end}}
{{Family tree/end}}


*On [[gross pathology]], [[Bloody sputum|Bloody]], Serous , Mucoid, Rusty, Pink frothy, and [[Purulent]] 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]].
*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/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.}}
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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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*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Decresed [[Lung volumes|tidal volume]]
*Decreased [[Lung volumes|tidal volume]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Clinical diagnosis.
*Clinical diagnosis.
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| style="background:#F5F5F5;" align="center" + |[[Acute]], [[Subacute]], [[Chronic]], recurrent
| style="background:#F5F5F5;" align="center" + |[[Acute]], [[Subacute]], [[Chronic]], recurrent
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Acute]]: Less than 4 weeks
*[[Acute]]: < four weeks
*[[Subacute]]: 4−12 weeks
*[[Subacute]]: four−twelve weeks
*[[Chronic]]: More than 12 weeks
*[[Chronic]]: > twelve weeks
*Recurrent: 4 or more episodes or acute rhinosinusitis per year
*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" + |−
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| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  X−Ray]]
*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  x−ray]]
| style="background:#F5F5F5;" + |
| 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]]
*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
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*Seasonal variation
*Seasonal variation
|-
|-
| style="background:#DCDCDC;" align="center" + |[[Bacterial Protracted Bonchitis]]<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:#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;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Atleast four weeks
*At least four weeks
| style="background:#F5F5F5;" align="center" + | +(Purulent)
| style="background:#F5F5F5;" align="center" + | +(Purulent)
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
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*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−ray]] to exclude other diseases
*[[Chest X-ray|Chest x−ray]] to exclude other diseases
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*FEV1 < 80%
*FEV1 < 80%
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*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest X−Ray]]
*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.
*Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
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| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
*Shift in [[Chest X-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
*Shift in [[Chest x-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
*[[Computed tomography|CT]] may be helpful
*[[Computed tomography|CT]] may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
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*[[Urinalysis]] & [[urine culture]] ( in infants)
*[[Urinalysis]] & [[urine culture]] ( in infants)
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Chest X-Ray|Chest X−Ray]] may be helpful
*[[Chest X-Ray|Chest x−ray]] may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
*Air trapping in [[Lung volumes]]
*Air trapped in [[Lungs]]
*Reduced [[DLCO|Diffusing capacity of carbon monoxide]] ( [[DLCO]])
*Decreased  [[DLCO|Diffusing capacity of Carbon Monoxide]] ( [[DLCO]])
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Clinical diagnosis
*Clinical diagnosis
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*Nasal Flaring, Grunting
*Nasal Flaring, Grunting
*Tachypnea, Tachycardia
*Tachypnea, Tachycardia
*vomiting
*Vomiting
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Leftward shift [[leukocytosis]]
*Leftward shift [[leukocytosis]]
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*[[Sputum culture]] in hospitalized patients
*[[Sputum culture]] in hospitalized patients
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest X−ray]]
*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest x−ray]]
*Anatomical changes observed in chest [[Computed tomography|CT]]
*Anatomical changes observed in chest [[Computed tomography|CT]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specific
*Not specific
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Infiltration observed in [[chest X-ray|chest X−ray]]
*Infiltration observed in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Community-acquired pneumonia|Community−acquired pneumonia]]
*[[Community-acquired pneumonia|Community−acquired pneumonia]]
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*[[Rhonchi]]
*[[Rhonchi]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Sputum [[acid-fast|acid−fast]] bacilli ([[Acid-fast|AFB]]) smear may be positive
*Sputum [[Acid-fast|AFB]] stain may be +.
*[[Mycobacterium|Mycobacterial]] [[Culture media|culture]] may be positive
*[[Mycobacterium Tuberculosis]] [[Culture media|culture]] may be +
*Molecular testing may be helpful
*Molecular testing may be helpful
| style="background:#F5F5F5;" + |
| 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]]
*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;" + |
| style="background:#F5F5F5;" + |
*Decreased [[FEV1]]
*Decreased [[FEV1]]
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*[[Complete blood count]]
*[[Complete blood count]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest X−ray]]
*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specific
*Not specific
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*[[Hoarseness]]
*[[Hoarseness]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specifc
*Not specific
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Electrocardiogram]] may be helpful
*[[Electrocardiogram]] may be helpful
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==Epidemiology and Demographics==
==Epidemiology and Demographics==


*[[Cough]] is one of the most common [[symptoms]] of [[children]] in [[Outpatient|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|Chronic Cough]] in [[children]] is approximately 5% to 10% in [[United States|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===
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===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|Preterm]] Birth and delivery by [[caesarian section]].
**[[Respiratory Distress Syndrome]].
**[[Respiratory Distress Syndrome]].
**[[Congenital Heart Disease]].
**[[Congenital Heart Disease]].
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==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 [[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.
*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, Acute cough can cause following [[Complications|complication]] 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>-
*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]]
**[[Otitis Media]]
**[[Rash]]
**[[Rash]]
**[[Vomiting]]
**[[Vomiting]]
**Diarrhea
**[[Diarrhea]]
**Bronchitis
**[[Bronchitis]]
**Pneumonia
**[[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>-
*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
**Inability to sleep
**Bronchospasm
**[[Bronchospasm]]
**Dizziness/ Syncope
**[[Dizziness]]/ [[Syncope]]
**Pneumothorax
**[[Pneumothorax]]
**Pneumomediastinum
**[[Pneumomediastinum]]
*Ribs fracture
*[[Rib fracture]]
 


*Prognosis is generally excellent in most of the causes of cough in children.
*[[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.
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**Grade.
**Grade.


A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating 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, household socioeconomic status, family history, Vaccination history, drug abuse and smoking in family members, atopy, Antenatal, perinatal, postnatal, Birth history, Developmental history, feeding history.
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.
The following signs are alarming which need further emergent evaluation by the physician:


:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
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===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]]
:*[[Breathlessness]] and episodes of [[coughing]]
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:*[[Failure to thrive]]
:*[[Failure to thrive]]
:*[[Fussiness]]
:*[[Fussiness]]
:*[[Chocking sensation]]([[Foreign body]] impaction)
:*[[Choking sensation]]([[Foreign body]] impaction)
:*[[Chills and Rigor]]
:*[[Chills and Rigor]]
:*[[Wheezing]]
:*[[Wheezing]]
:*[[Headache]], [[myalgia]], [[fatigue]]
:*[[Headache]], [[myalgia]], [[fatigue]]
       
 
===Physical Examination===
===Physical Examination===


*Patients with Cough 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 muscle usage needs prompt evaluation.
*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:


*Vital signs: Documentation according to patient's age-
*Vital signs: Documentation according to patient's [[age]]
**Temperature
**[[Blood pressure]]
**Heart rate
**[[Temperature]]
**Respiratory rate
**[[Respiratory rate]]
**Blood pressure
**[[Heart rate]]
**Growth and developmental parameters: Weight, Height, Length, Occipito Frontal Circumferance
 
*General Appearence: Level of consciousness, Cyanosis, Distressed or ill appearing, Hydration and nutritional status.
**[[Growth]] charts and [[Human development (biology)|developmental]] milestones: [[weight]], [[height]], [[length]], occipitofrontal circumference
*Skin: Turgor, color, texture, rashes or any other abnormal findings.
*General Appearance: Level of [[consciousness]], [[Cyanosis]], Distressed or ill-appearing, hydration and nutritional status.
*Lymphatics: Lymphadenopathy, location, Number and size, consistency, adherence to underlying structures.
*[[Skin]]: [[Turgor]], [[color]], texture, [[Rash|rashes]] or any other abnormal findings.
*Head: Size, shape, fontanelle, overlapping suture, scalp, hair.
*[[Lymphatics]]: [[Lymphadenopathy]], location, number and size, consistency, adherence to underlying structures.
*Eyes: Lacrimation, conjuntival injection, periorbital redness.
*[[Head]]: Size, shape, [[Fontanelle|fontanelle,]] overlapping [[suture]], [[scalp]], [[hair]].
*Ears: Position of ears along with external auditory canal, tympanic membrane visualization.
*[[Eyes]]: [[Lacrimation]], [[redness]], [[irritation]],  [[conjunctival injection]], [[Periorbital Edema|periorbital]] redness.
*Nose: Any deviation of nasal septum, normal or hypertrophied inferior turbinates, nasal polyps and congesion, nasal discharge, tenderness over sinus point.
*[[Ears]]: Position of ears along with [[external auditory canal]], [[tympanic membrane]] visualization.
*Mouth and throat:
*[[Nose]]: Any deviation of [[nasal septum]], normal or hypertrophied inferior [[Nasal concha|turbinate]], [[nasal polyps]] and [[congestion]], [[nasal discharge]], tenderness over [[sinus]] point.
**Lips: Color and congenital lesions.
*[[Mouth]] and [[throat]]: Look for any associated abnormality
**Buccal mucosa: Hydration, Color, Presence of anomaly.
**[[Lips]]: [[Color]], [[Mucous membrane|mucosal]] abnormality and [[congenital]] lesions.
**Tongue and teeth and gum: Developmental anomaly, Color, papllae.
**[[Buccal mucosa]]: Hydration, Color, Presence of anomaly.
**Palate: Anomaly, arch.
**[[Tongue]] and [[teeth]] and [[Gingiva|gum]]: Developmental anomaly, Color, [[papillae]].
**Tonsils: Color, Size, Any membrane, calcification and Exudates.
**[[Palate]]: [[Anomaly]], arch.
**Posterior pharyngeal wall: Color, appearence.
**[[Tonsils]]: Color, size, any [[membrane]], [[calcification]] and exudates.
**Gag reflex: Intact or not.
**Posterior pharyngeal wall: Color, appearance.
*Neck: Throid, Trachea position and examination, Any Cystic or nodular masses, presence of Nuchal Rigidity.
**[[Gag reflex]]: Intact or not.
*Respiratory:  
*[[Neck]]: [[Thyroid]], [[trachea]] position and examination, any [[cystic]] or [[nodular]] masses, presence of [[nuchal rigidity]].
**Inspection: Breathing pattern(Abdominal and periodic), Respiratory rate, Accessory muscle usage, Chest wall shape.
*[[Respiratory system|Respiratory]]:  
**Auscultation: Breath sound symetry, vesicular, bronchial, rales, rhonchi, wheezes, stridor.
**[[Inspection (medicine)|Inspection]]: Breathing pattern (abdominal and periodic), respiratory rate, accessory muscle usage, chest wall shape.
**Percussion: Resonance, hyperresonance and dull.
**[[Auscultation]]: breath sound symmetry, [[vesicular]], [[bronchial]], [[rales]], [[rhonchi]], wheezes, [[stridor]].
**Palpation: Trachea position, Tactile fremitus.
**[[Percussion]]: [[resonance]], hyper resonance and dull.
*Cardiovascular: Rhythm, murmur, any radiation of sound, pulse in both extremities.
**[[Palpation]]: [[trachea]] position, [[tactile fremitus]].
*Gastrointestinal: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses. or rebound guarding.
*[[Cardiovascular]]: [[rhythm]], [[heart murmur|murmur]], any radiation of sound, [[pulse]] in both extremities.
*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.
*[[Gastrointestinal tract|Gastrointestinal]]: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses or rebound guarding.
*CNS: Primitive reflex, superficial and deep tendon reflex, strength and tone of muscles, cranial nerve examination.
*[[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]].
*Genitourinary: Presence of external genitalia deformity , hydrocele, cryptorchidism or hernia.
*[[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 cough. Laboratory test 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>.
*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|Complete Blood Count]]
*Arterial blood gas analysis
*[[Arterial blood gases|Arterial blood gas analysis]]
*Culture of nasopharyngeal swab and Broncho alveolar lavage
*[[Culture medium|Culture]] of nasopharyngeal swab and broncho alveolar lavage
*Gross and microscopic analysis and culture of sputum
*[[Gross examination|Gross]] and [[Microscopic examination|microscopic]] analysis and [[Sputum culture|culture of sputum]]
*AFB testing and tuberculosis screening
*[[AFB stain|AFB]] testing and [[tuberculosis]] screening
*Allergy test
*[[Allergy]] test
*Serum Immunoglobulins, autoantibodies
*Serum [[Immunoglobulins]], [[autoantibodies]]
*Sweat test
*[[Sweat test]]
*Exhaled Nitric oxide test
*Exhaled [[nitric oxide]] test
*Esophageal pH
*[[Esophageal|Esophagea]]<nowiki/>l [[pH]]
*Serology for Pertusis, CMV, Chlamydia, HIV.
*Serology for Pertusis, CMV, Chlamydia, HIV.


===Electrocardiogram===
===Electrocardiogram===
An ECG may not be helpful in the diagnosis of congenital heart disease, valvular heart disease, myocarditis in children.
An [[The electrocardiogram|ECG]] may not be helpful in the diagnosis of [[congenital heart disease]], [[myocarditis]], [[valvular heart disease]], in children.


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


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
Echocardiography/ultrasound  may be helpful in the diagnosis of causes of cough in children. Echocardiographic findings aids in diagnosis of congenital heart disease, whereas USG findings can help in evaluating complication like peritonsilar abscess, retropharyngeal abscess promptly.
[[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.


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


===MRI===
===MRI===
Chest MRI may be helpful in the diagnosis of 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.
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.


===Other Imaging Findings===
===Other Imaging Findings===
Other imaging techniques are used to evaluate causes of cough in children.
Other [[imaging]] techniques are used to evaluate causes of [[cough in children]].


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


===Other Diagnostic Studies===
===Other Diagnostic Studies===


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


*Spirometry for evaluating pulmonary function test.
*[[Spirometry]] for evaluating [[Pulmonary function test|pulmonary function test.]]
*Bronchodilator provocation test.
*[[Bronchodilators|Bronchodilator]] [[Provocation study|provocatio]]<nowiki/>n test.
*Ciliary function test.
*Ciliary function test.
*Genetic analysis for CFTR mutation, Primary ciliary dyskinesia etc.
*[[Genetic analysis]] for [[Cystic fibrosis transmembrane conductance regulator|CFTR]] [[mutation]], [[Primary ciliary dyskinesia]] etc.
*Video fluoroscopic or endoscopic swallow evaluation.
*Video [[fluoroscopic]] or [[Endoscopic|endoscopic swallow]] evaluation.
*Environmental assessment.
*Environmental assessment.


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*The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in 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>
*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.
*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 gove comfort to child.
*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:
*Medical management:
**Antihistamine, antitussive medications and nasal decongestant are provided for alleviating symptoms of acute cough. Allergic conditions are treated with steroids.
**[[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
**Brochodialators(Ipratropium bromide, Albuterol, Salmeterol, Salbutemol), Antibiotic (Amoxicillin/Clavulanate, Cephalosporins, Respiratory fluroquinolones, Anti viral, Antifungal, Antiparasitic) are used according to evidence based management of particular causes of cough in children.
**[[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===


*Some surgical procedure are performed for patients with Tonsilitis, adenoid hypertrophy, severe cases of laryngomalacia, tracheoesophageal fistula, congenital heart disease, complications of any disease or trauma in ear, nose, sinuses, pharynx, larynx, trachea, bronchus, lungs, ribs.
*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]].
   
   
===Prevention===
===Prevention===


*Effective measures for the primary prevention of cough include-
*Effective measures for the [[primary prevention]] of cough include:
**Care givers should be given health education on pros and cons of vaccination, alarming features of cough.
**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.
**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.
**Head should be raised to prevent irritations in [[throat]].
**Humidified air will help clearing the sputum easily.
**Humidified air will help clearing the sputum easily.
**Adequate hydration to prevent formation of dry sputum.
**Adequate [[hydration]] to prevent formation of [[dry sputum]].
**Avoidance of triggers in case of atopic patient.
**Avoidance of triggers in case of [[atopic]] patient.
**Nutritional balances should be maintained for rebooting the immunity.
**[[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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  2. Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J (April 2009). "Semantics and types of cough". Pulm Pharmacol Ther. 22 (2): 139–42. doi:10.1016/j.pupt.2008.12.008. PMID 19136069.
  3. Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (June 2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMID 22958367.
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  7. Abdallah C (July 2012). "Acute epiglottitis: Trends, diagnosis and management". Saudi J Anaesth. 6 (3): 279–81. doi:10.4103/1658-354X.101222. PMC 3498669. PMID 23162404.
  8. "Epiglottitis, Acute Laryngitis, and Croup".
  9. Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
  10. Bellamy EA, Johnston ID, Wilson AG (1987). "The chest radiograph in whooping cough". Clin Radiol. 38 (1): 39–43. PMID 3816065.
  11. "Pertussis | Whooping Cough | Clinical | Information | CDC".
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  16. Kumar V (February 2017). "Influenza in Children". Indian J Pediatr. 84 (2): 139–143. doi:10.1007/s12098-016-2232-x. PMID 27641976.
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  19. Shahid SK (2012). "Rhinosinusitis in children". ISRN Otolaryngol. 2012: 851831. doi:10.5402/2012/851831. PMC 3671714. PMID 23762621.
  20. Gelfand EW (May 2009). "Pediatric asthma: a different disease". Proc Am Thorac Soc. 6 (3): 278–82. doi:10.1513/pats.200808-090RM. PMC 2677403. PMID 19387030.
  21. van Aalderen WM (2012). "Childhood asthma: diagnosis and treatment". Scientifica (Cairo). 2012: 674204. doi:10.6064/2012/674204. PMC 3820621. PMID 24278725.
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  23. "www.thoracic.org" (PDF).
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  30. Friedman JN, Rieder MJ, Walton JM (November 2014). "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age". Paediatr Child Health. 19 (9): 485–98. doi:10.1093/pch/19.9.485. PMC 4235450. PMID 25414585.
  31. Smith DK, Seales S, Budzik C (January 2017). "Respiratory Syncytial Virus Bronchiolitis in Children". Am Fam Physician. 95 (2): 94–99. PMID 28084708.
  32. Katz SE, Williams DJ (March 2018). "Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research". Infect Dis Clin North Am. 32 (1): 47–63. doi:10.1016/j.idc.2017.11.002. PMC 5801082. PMID 29269189.
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