- A pediatric chronic cough is defined as a persistent cough lasting for over 4 weeks in children aged <14 years.
- Chronic cough can be classified into different categories based on its diagnosis, management techniques, or presenting symptoms.
- A common paradigm is to classify cough as normal (expected), specific (with cough pointers), and nonspecific types.
- A group of researchers focused on the diagnostic process for children with chronic cough in outpatient settings, as the challenge in pediatric cough diagnosis lies in its varied causes and frequent coinciding symptoms.
Cough evaluation by the aerodigestive team
Core team members
Care coordinator, gastroenterology, nursing, otolaryngology, pulmonology,
Other specialists
Allergy/immunology, neurology, cardiology, infectious disease, and psychiatry
Availability bias
Results in diagnostic errors in the clinical setting and can lead to different diagnoses
Solution for the availability bias
Adhering to a standardized protocol can reduce the risk of bias and facilitate the comparison of efficacy and identification of priorities for future research and protocol modifications
Treatment based on set protocol vs. conventional practice
Higher number of children experience resolution of symptoms by day 56 (58% vs. 40%)
Key questions to ask when diagnosing and treating pediatric chronic cough
1. Does the cough have specific pointers, classic features, or chest radiograph and spirometry abnormalities?
If so, then consider treatments for diseases associated with specific pointers, if not, then continue as following:
a. Classic coughs include the croupy/barking cough of tracheomalacia, the staccato cough for chlamydia, cough with casts, and the whoop for pertussis.
b. Assess risk factors for foreign body inhalation and contributions from rhinosinusitis and reflux.
2. Is the cough wet?
If so, consider treatment of protracted bacterial bronchitis.
a. Consider checking immune status, pertussis, and mycoplasma.
3. Is the cough dry?
If so, consider inhaled corticosteroids for 2 weeks for asthma/ asthma-like illnesses.
A comprehensive evaluation by an aerodigestive team leads to improved care and reduces the risk of specialty availability bias.
Reference:
Jiang ZY, Gatcliffe C, Mai T, et al. Aerodigestive approach to pediatric chronic cough. Otolaryngol Clin North Am. 2022;55(6):1233–1242.