Chronic Cough

Chronic cough in children is defined as a cough that lasts from more than four weeks.  An occasional cough is a normal biological response to prevent infection by clearing secretions or foreign substances from the lungs.

Signs and Symptoms of Chronic Cough in Children

• Nasal Congestion or a Runny Nose (Rhinorrhea)
• Post Nasal Drip (PND)
• Wheezing
• Shortness of Breath (SOB)
• Frequent Throat Clearing
• Sore Throat
• Hoarseness
• Complications of Chronic Cough

A chronic cough can be annoying, but it can also take its toll on the body especially for children. Constant coughing can lead to interrupted sleep or inability to sleep, headache, dizziness and in severe cases, vomiting, lightheadedness or rib fractures. When a cough persist for 4 weeks, it is important for your child to see a doctor to diagnose the underlying cause.

Common Causes of Chronic Cough

When a cough does not go away or last longer than normal, there are typically one or more underlying causes. Pinpointing the exact cause can be important for effective treatment. The vast majority of chronic cough cases are caused by asthma, postnasal drip or reflux or some combination of the three.

• Asthma: A cough is a common symptom with asthma, especially after upper respiratory infection or exposure to triggers or irritants.
• Cough-variant asthma: With this specific type of asthma, a cough is the main symptom.
• Postnasal drip: Mucus from the sinuses or nasal passages drips down the back of the throat to elicit a cough reflex.
• Gastroesophageal reflux disease (GERD): This condition causes stomach acid to flow back into the esophagus and throat. The irritation can lead to a chronic cough and the condition can actually be made worse by the cough.

Other Causes of Chronic Cough

• Infections: Sometimes a cough can last long after the other symptoms of an upper respiratory tract infection, cold or flu.
• Chronic Bronchitis: Chronic inflammation of the bronchial tubes that can be accompanied by coughing, wheezing, or shortness of breath.
• Bronchiolitis: Usually caused by a viral infections such as respiratory syncytial virus (RSV)

Less common causes of chronic cough:

• Foreign body aspiration: Typically only seen in young children
• Chronic bronchitis from an infectious disease
• Cystic Fibrosis
• Laryngopharyngeal reflux or silent reflux
• Bronchiectasis
• Benign motor tic
• Habit cough that develops after an episode of acute cough
• Airway irritant such as second-hand smoke

Diagnosis of Chronic Cough in Children

When treatment for the most common causes of chronic cough fail to improve symptoms, further testing is done. Dr. Schochet, Dr. Lie and their team will use a detailed medical history and an analysis of symptoms to determine which test to perform. Some things that will be evaluated include:

• Duration of the cough
• Intensity of the cough
• Character and sound of the cough
• Events leading up to the cough
• Things that worsen or improve the cough
• Health before cough
• Environmental factors and influences

Testing for Asthma

The goal of testing will be to determine the underlying cause of your child’s chronic cough and wheezing. The most common tests to preform on children with chronic cough are x-rays and spirometry tests, but any combination of the following test may be ordered.

• Imaging test: X-rays and CT scans may be used to check for pneumonia, certain lung diseases or sinus infections.
• Pulmonary Function Tests (PFTs): A common lung function test like spirometry is used to diagnose asthma and evaluate lung function.
• Lab Test: Sometimes done to test for bacteria in in mucus that is coughed up.
• Bronchoscopy is an endoscopic technique of visualizing the inside of the airways by inserting a fiberoptic endoscope containing a camera. This technique of visualizing the inside of the airways is for diagnostic and therapeutic purposes.

Treating Chronic Cough in Children

Determining the cause can make an impact on the type of treatment and the effectiveness of treatment. Medication is typically the most effective way to treat chronic cough, but a number of things you can do at home will help as well.

• Medications
• Some of the common medications that may be used to treat and control chronic cough include:
• Antihistamines to treat allergies
• Decongestants to treat postnasal drip
• Antibiotics to treat infections
• Acid blockers to treat reflux
• Asthma maintenance medications

When to See a Doctor About Your Child’s Chronic Cough

• When a child is less than three months of age or was born prematurely
• When a child is struggling to breath comfortably
• When a child can’t catch breath during episodes of coughing
• Coughs so hard that repeated vomiting occurs
• When a cough last longer than two weeks

Read more about when to see a pediatric pulmonologist, Dr. Peter Schochet and Dr. Hauw Lie, who specialize in children’s lung disease.

For more information about chronic cough and pediatric respiratory disease please submit an online appointment request or contact the office of Dr. Peter N. Schochet.