Chronic cough (CC) is the most common reason for increased visits to pediatric and urgent care clinics.
Outcomes of CC include impaired quality of life, missed school days, inappropriate antibiotic usage, multiple physician visits in children.
The need for multi-disciplinary approach
A multi-disciplinary approach could be beneficial because:
- Conditions assessed and diagnosed by specialists could be different from those assessed by a general pediatrician
- Aids in early diagnosis and choosing appropriate treatment strategies
Otolaryngologists
- Aid in earlier identification of those cases of CC that require diagnostic work up and surgical intervention
Pulmonologists
- Important in cases of failure of the cough to resolve, recurrence, or concern for an underlying disease
- Diagnostic tests such as radiography (x-ray or CT), pulmonary function testing, and flexible bronchoscopy (FB) with broncho-alveolar lavage can be coordinated only with a pulmonologist
Gastroenterologists
- Important when GERD is the cause of CC
- GERD therapeutic approaches cannot be used for CC, until other clinical features of GERD are evident
- Detecting other features by esophagogastroduodenoscopy or endoscopy and further treatment requires a gastroenterologist
Studies evidence a 20%–40% cost savings for children who are managed comprehensively in a multidisciplinary setting compared to a single specialty evaluation. Several studies also support that a multi-disciplinary approach aids in correct diagnosis and adopting proper therapeutic strategies.
Appropriate referral and evaluation of persistent/recalcitrant cough by a multidisciplinary team may lead to earlier accurate diagnosis with likely cost savings.
Reference: Mukerji SS, Yenduri NJS, Chiou E, et al. A multi-disciplinary approach to chronic cough in children. Laryngoscope Investig Otolaryngol. 2022;7(2):409–416.