6 September 2017

Chronic cough in kids shouldn’t be trivialised

Clinical Paediatrics Respiratory

A cough that persists for more than one month in children is likely to indicate a more serious condition, a Brisbane study has shown.

It is common for a cough to linger after an acute respiratory illness in children. However, most children recover within two or three weeks, with only a small proportion continuing to cough at the four-week mark.

The study of more than 800 children found that a cough lasting more than four weeks was frequently a sign of a bacterial infection or an underlying medical condition.1

Around half of children with chronic cough (47%) were found to have protracted bacterial bronchitis.

Importantly, one-third of children who were still coughing after one month were diagnosed with a new and serious chronic lung disease, following review by a paediatric respiratory physician.

These conditions included asthma (15%), tracheobronchomalacia (11%), obstructive sleep apnoea (3%), aspiration disorder (3%) and bronchiectasis (3%).

The prospective study included children under the age of 15 who presented to an emergency department in Brisbane with a respiratory infection that included cough as a symptom.

The children were then followed up for four weeks after presentation.

Researchers found around one in five children still had cough at 28 days. On further examination, the majority of these children (72%) were found to have a specific respiratory disorder and the rest were diagnosed with non-specific cough, postviral cough or recurrent upper respiratory tract infection.

“Cough in children is often trivialised,” Kerry-Ann O’Grady, study author and epidemiologist at the Centre for Children’s Health Research in Brisbane, said.

Families often presented up to four or five times to a GP for their child’s cough before being referred for specialist review, she said.

Investigation of chronic cough in children need to be occurring much earlier, as per Australian Cough Guidelines2, Ms O’Grady said.

“If you don’t treat protracted bacterial bronchitis you can end up getting a chronic inflammatory process … that [may] eventually lead to permanent lung damage,” she said.

Protracted bacterial bronchitis is readily treatable with antibiotics. The main sign of protracted bacterial bronchitis is chronic wet cough.

Pertussis, mycoplasma infection and pneumonia should also be ruled out in children with chronic wet cough.

References:

1. Archives of Disease in Childhood 2017, online 16 August

2. mja.com.au/journal/2010/192/5/cicada-cough-children-and-adults-diagnosis-and-assessment-australian-cough

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