Algorithm for the evaluation of chronic cough in children

F_eNO: exhaled nitric oxide fraction; PBB: protracted bacterial bronchitis; TB: tuberculosis; CF: cystic fibrosis; PCD: primary ciliary dyskinesia.

* Specific cough pointers include^[1]:

Symptoms – Chronic wet/productive cough, chest pain, history suggestive of inhaled foreign body, dyspnea, exertional dyspnea, hemoptysis, failure to thrive, feeding difficulties (including choking/vomiting), cardiac or neurodevelopmental abnormalities, recurrent sinopulmonary infections, immunodeficiency, or epidemiologic risk factors for exposure to TB
Signs – Respiratory distress, digital clubbing, chest wall deformity, or auscultatory crackles
Tests – Chest radiographic changes (other than perihilar changes) or lung function abnormalities

Refer to UpToDate content on chronic cough in children.

¶ Habit cough (also known as tic cough) is typically absent at night or when distracted and may be honking or short/dry^[2].

Δ F_eNO value ≥25 ppb with asthma symptoms supports a diagnosis of asthma^[3].

◊ For diagnostic evaluation, refer to UpToDate content on pertussis and tracheomalacia. Tic (habit) cough is diagnosed based on characteristic symptoms.

References:

Kantar A, Chang AB, Shields MD, et al. ERS statement on protracted bacterial bronchitis in children. Eur Respir J 2017; 50: 1602139.
Weinberger M, Hoegger M. The cough without a cause: Habit cough syndrome. J Allergy Clin Immunol 2016; 137:930.
Gaillard EA, Kuehni CE, Turner S, et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years. Eur Respir J 2021; 58:2004173.

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Algorithm for the evaluation of chronic cough in children