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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Causes of chronic cough in children

Causes of chronic cough in children
Primary cause Risk factors or mechanisms Major evaluation method (in addition to clinical findings)
Pulmonary causes
Aspiration* (recurrent small volume)
  • Primary swallowing dysfunction or laryngeal disorders (eg, laryngeal cleft, tracheoesophageal fistula), gastroesophageal reflux, achalasia
  • Swallowing assessment (eg, videofluoroscopic) and other evaluation as indicated
Asthma, cough-dominant asthma*
  • Genetics, environment, atopy, postacute respiratory infections
  • Spirometry, FeNO, airway hyperresponsiveness
Chronic endobronchial suppurative disease* (protracted bacterial bronchitis, chronic suppurative lung disease, bronchiectasis)
  • Cystic fibrosis
  • Immunodeficiency (primary or secondary)
  • Primary ciliary dyskinesia
  • Aspiration
  • Postinfection (eg, tuberculosis, pneumonia, etc)
  • Sweat test, genetic screening
  • Evaluation of immune function
  • Cilia biopsy, genetic testing
  • Chest CT, bronchoscopy
  • Refer to "Aspiration" above
Chronic pneumonia*
  • Chronic atelectasis, mucous plugging, plastic bronchitis
  • Pathogens include tuberculosis, nontuberculosis mycobacteria, mycoplasma, fungi, and chlamydia
  • Chest CT, bronchoscopy
  • Relevant microbial assessment (eg, QuantiFERON gold and Gene Xpert for tuberculosis)
Eosinophilic lung disease*
  • Primary or secondary (ie, related to parasitic disease)
  • Bloods and bronchoalveolar lavage
Inhaled retained foreign body*
  • Young child, history of choking (even if days or weeks before cough onset)
  • Bronchoscopy
Interstitial lung disease*
  • Primary genetic abnormality, post-severe infection bronchiolitis obliterans, autoimmune disease, radiation, drugs
  • Relevant genetic or autoimmune test (with or without lung biopsy), chest CT
Mechanical inefficiency
  • Tracheobronchomalacia and other airway anomalies
  • Vascular rings or other anomalies that cause tracheal narrowing
  • Dynamic bronchoscopy
  • Chest CT with contrast
  • Chest MRI (if vascular cause suspected)?
Noninfective bronchitis*
  • Exposure to environmental pollutants (eg, tobacco smoke, fungi, traffic)
  • History and removal of trigger
Postinfection (self-resolving)
  • Viral infections, pertussis, parapertussis
  • PCR and/or serology
Space-occupying lesions*
  • Cysts and tumors
  • Chest CT or MRI scan
Extrapulmonary causes
Causal role likely
Cardiac*
  • May cause cough due to airway compression, pulmonary edema, or arrhythmia
  • ECG and other evaluation as indicated
Ear disease*
  • Oto-respiratory reflex (Arnold reflex), in which stimulation of the auricular branch of the vagus nerve triggers cough
  • Examination of the ear canal and removal of the object, or treatment of disease that is triggering the cough
Tic cough (habit cough) or somatic cough disorder (psychogenic cough)*
  • May be isolated, but more likely if other tics are present
  • Some children have generalized anxiety or disproportionate anxiety about the seriousness of their symptoms
  • Suppressibility, distractibility, suggestibility, variability, and presence of a premonitory sensation; cough absent during sleep
  • Response to behavioral therapy (eg, suggestion therapy)Δ
  • Children with somatic cough disorder may require referral to a psychologist and/or psychiatrist if unresponsive to suggestion therapy
Medications*
  • ACE inhibitors (common), any inhaled medication, proton pump inhibitors, other drugs (uncommon)
  • Certain other medications (eg, cytotoxic drugs) may be associated with interstitial lung disease
  • Discontinuation of medication
  • Evaluation for interstitial lung disease (eg, HRCT)
Causal role unlikely
Esophageal disorders
  • Gastroesophageal reflux (acid and nonacid) and eosinophilic esophagitis
  • Esophageal pH monitoring or impedance monitoring, with or without endoscopy
Upper airway pathology
  • Chronic sinusitis, obstructive sleep disorders
  • Evaluation guided by suspected disorder (CT, polysomnography)

FeNO: exhaled nitric oxide fraction; CT: computed tomography; MRI: magnetic resonance imaging; PCR: polymerase chain reaction; ECG: echocardiogram; ACE: angiotensin-converting enzyme; HRCT: high-resolution computed tomography.

* Children with these disorders typically have specific signs and symptoms that are clues to the underlying disease, sometimes known as specific cough "pointers."

¶ Evaluation for suspected aspiration may include bronchoscopy, esophageal pH monitoring or impedance monitoring, endoscopy, or nuclear medicine scans. Refer to UpToDate topic on evaluation of children with suspected swallowing dysfunction.

Δ Refer to UpToDate table on suggestion therapy for habit cough.

◊ Possibly related to aspiration of secretions rather than primary pathology.
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