Approach to child with chronic or recurrent cough
Objectives
To know
– the right questions to ask
– age-related differentials and investigating appropriately
– how to manage the child with chronic cough using a systematic approach
Outline
Definition
Mechanism/ phases of cough
Classification
Asking the right questions
Age-related differentials
Investigating the child
Managing the child
Definition
Cough – common indication of respiratory illness and is one main symptom of children seeking medical attention
It is an explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree of secretions and foreign material.
Mechanism of cough
Expiratory phase: opening of the glottis results in high expiratory flow and audible coughs. During this phase, the airway undergoes dynamic compression and the expulsion of air facilitates airway debris and secretions clearance.
HOW DO WE NARROW OUR DIAGNOSIS WHILE APPROACHING A CHILD WITH COUGH
GOOD HISTORY
Onset; Productive; Character; Variation
• Onset
sudden -after choking episode- foreign body, with feeds – GERD,
With ETS exposure
recurrent- atopic type,
chronic- TB, bronchiectasis
• Productive
older children with early morning severe expectoration- Bronchiectasis,
non- productive and only when awake- habitual; -asthma
• Variation
nocturnal and early morning- atopic type, seasonal – hay fever/asthma
lying down- GERD, postural – bronchiectasis, postnasal drip, cardiac
• Character/timing/associated factors
– Barking- croup,
spasmodic- atopic type
Whoop, sounds, stridor, voice change, fever
GOOD PHYSICAL EXAMINATION
Blood shot eye, clubbing
AGE MATTERS…….
The child’s age is a key guide
The child’s age is a key guide.
In another study, persistent bacterial bronchitis (PBB), post-infectious causes, and bronchiectasis accounted for a combined 68% of cases.
In the 2 reviews involving older children, the corresponding totals for these 3 diagnoses were 5% and 40% (the latter included PBB, 35%), respectively.
Investigating the child….
Managing chronic cough – an algorithm
Specific diseases that cause cough
PBB
TB
PERTUSIS
ASTHMA/ABPA
CF
GERD
PCD
CSLD
FB
Nutritional/environmental/health education/life style modification
IN SUMMARY – remember
– the right questions to ask
– age-related differentials and how to investigate appropriately
– how to manage the child with chronic cough using a systematic approach
REFERENCES
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