Cough resident survival guide (pediatrics)

Revision as of 19:47, 13 September 2020 by TayyabaAli (talk | contribs) (→‎Overview)
Jump to navigation Jump to search


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

Synonyms and keywords: Cough in childhood, Cough in children, An approach to cough in children

Cough resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Cough is a sudden, often repetitive, spasmodic contraction of the thoracic cavity, resulting in a violent release of air from the lungs, and usually accompanied by a distinctive sound. A cough by itself is not a complete diagnosis but rather a symptom of an underlying condition, despite this, it accounts for one of the most common indications for visits to the general practitioners and family physicians with a good proportion of these cases resulting in a pulmonology referral.

Coughing is an action the body takes to get rid of substances that are irritating the air passages. The act of coughing can be triggered by a myriad of conditions physiologic and otherwise, A cough is mostly initiated to clear a buildup of phlegm within the trachea. Coughing can also be triggered by a bolus of food entering the trachea and other parts of the respiratory tree rather than the esophagus due to a failure of the epiglottis function.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Acute cough (less than 3 weeks)[4] Subacute (3 to 8 weeks) or chronic cough (3 to 4 months)[5]

Isolated cough: otherwise healthy child

Diagnosis

The approach to diagnosis of Cough in children is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of Cough.[6][7]

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order Chest X-ray or spirometry (if child is able to perform)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider the diagnosis of Bacterial bronchitis
 
 
 
Consider the diagnosis of Asthma
❑ History of bilateral wheeze and exertional dyspnea
❑ Absence of other cough symptoms
❑ Absence of findings on lung examination
Reversible obstructive defect or normal finding on spirometry (if performed)
 
Consider the diagnosis of Retained foreign body
❑ History of choking or sudden onset of symptoms
❑ Monophonic or unilateral wheeze
❑ Chest X-ray finding suggesting foreign body
 
Consider the other type of cough
Tracheomalacia
Pertussis
Habit cough/ tic cough (typically absent at night or when distracted and may be honking or short/dry)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Antibiotics for 2 to 4 weeks
 
 
 
Trial of Asthma therapies for 2 to 4 weeks
 
 
Perform tests to confirm the diagnosis and treat as appropriate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cough resolves
❑ Likely bacterial bronchitis
❑ Reassess in 3 to 4 months to confirm that child remains well
 
Productive cough continues after 4 weeks
❑ Consider the diagnosis of:
 
Asthma Improved
❑ Continue treatment
Asthma not improved
❑ Reassess for other causes of cough
 
No foreign body
❑ Reassess for other causes of cough

Treatment

Shown below is an algorithm summarizing the treatment of underlying conditions that cause cough.

Acute cough

 
 
 
 
 
 
 
 
 
 
 
 
Treat the underlying causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cough due to Bronchiolitis[8]
❑ Supportive care such as hydration, saline nasal drops, nasal bulb suction
❑ Prevention includes Palivizumab for infants with the following conditions:
 
Cough due to Common Cold[9]
❑ Supportivr care such as hydration, saline nasal drops
❑ Combination of over the counter medications such as antihistamines, decongestants, antitussives, expectorants, mucolytics, antipyretics/analgesics
❑ For fever, acetaminophen (for children older than three months) or ibuprofen (for children older than six months)
 
{{{ C03 }}}
 
{{{ C04 }}}
 
{{{ C05 }}}
 
{{{ C06 }}}
 
{{{ C07 }}}

Chronic cough

 
 
 
 
 
 
 
 
 
 
 
 
Treat the underlying causes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ C02 }}}
 
{{{ C03 }}}
 
{{{ C04 }}}
 
{{{ C05 }}}
 
{{{ C06 }}}
 
{{{ C07 }}}

Do's

  • "For children aged less than 14-years with chronic cough (> 4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with gastroesophageal pathological reflux, they should be treated for GERD in accordance to evidence-based GERD specific guidelines (Grade 1B)." [10][11]
  • "Children with chronic cough and typical symptoms of GERD should undergo medical treatment—dietary, lifestyle modifications and acid suppression therapy. A three-stage therapeutic trial should be completed before diagnosing reflux-related cough:
(1) clear-cut response to a 4 to 8-week treatment with PPI
(2) relapse on stopping medication
(3) new response to recommencing medication, with weaning down therapy as appropriate to the child’s symptoms." [12]

Don'ts

References

  1. Patocka C, Nemeth J (2012). "Pulmonary embolism in pediatrics". J Emerg Med. 42 (1): 105–16. doi:10.1016/j.jemermed.2011.03.006. PMID 21530139.
  2. Tan TQ, Mason EO, Wald ER, Barson WJ, Schutze GE, Bradley JS; et al. (2002). "Clinical characteristics of children with complicated pneumonia caused by Streptococcus pneumoniae". Pediatrics. 110 (1 Pt 1): 1–6. doi:10.1542/peds.110.1.1. PMID 12093940.
  3. "Acute Asthma: Observations Regarding the Management of a Pediatric Emergency Room | American Academy of Pediatrics".
  4. 4.0 4.1 "www.ncbi.nlm.nih.gov" (PDF).
  5. 5.0 5.1 de Jongste JC, Shields MD (2003). "Cough . 2: Chronic cough in children". Thorax. 58 (11): 998–1003. doi:10.1136/thorax.58.11.998. PMC 1746521. PMID 14586058.
  6. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S; et al. (2017). "Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure". Eur Respir J. 50 (2). doi:10.1183/13993003.02426-2016. PMID 28860265.
  7. Weinberger M, Hoegger M (2016). "The cough without a cause: Habit cough syndrome". J Allergy Clin Immunol. 137 (3): 930–1. doi:10.1016/j.jaci.2015.09.002. PMID 26483178.
  8. King VJ, Viswanathan M, Bordley WC, Jackman AM, Sutton SF, Lohr KN; et al. (2004). "Pharmacologic treatment of bronchiolitis in infants and children: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 127–37. doi:10.1001/archpedi.158.2.127. PMID 14757604.
  9. "Treatment of the Common Cold - American Family Physician".
  10. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F; et al. (2018). "Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition". J Pediatr Gastroenterol Nutr. 66 (3): 516–554. doi:10.1097/MPG.0000000000001889. PMC 5958910. PMID 29470322.
  11. "Overview | Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance | NICE".
  12. 12.0 12.1 de Benedictis FM, Bush A (2018). "Respiratory manifestations of gastro-oesophageal reflux in children". Arch Dis Child. 103 (3): 292–296. doi:10.1136/archdischild-2017-312890. PMID 28882881.
  13. 13.0 13.1 "journal.chestnet.org".
  14. Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K; et al. (2017). "Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report". Chest. 151 (4): 884–890. doi:10.1016/j.chest.2017.01.025. PMID 28143696.


Template:WikiDoc Sources