Tracheomalacia nocturnal cough12/9/2023 No studies have clearly defined when cough should be defined as chronic. Presumably, however, both the specific microbe (eg, cough is more likely to be prolonged after a potent respiratory infection such as pertussis) and host factors (eg, genetic predisposition to bronchitis) play a role. Further, it is unknown why the cough associated with common acute viral upper respiratory tract infection (URTI) resolves in most, yet persists in some. It is unknown whether the primary stimulus for chronic cough in many children is identical to that for acute cough. 9 Consequently, based on current data, we recommend that acute cough be defined as cough of < 14 days duration. An Australian prospective community study recorded respiratory episodes of 2.2–5.3 per person-year for children aged ≤ 10 years, with mean duration of episodes of 5.5–6.8 days. 8 However, it is not known if those with cough persisting for > 25 days had features consistent with protracted bronchitis or other identifiable complications (Dr Alistair Hay, Lecturer in Primary Healthcare, University of Bristol, personal communication). A prospective study (1999–2001) of acute cough showed recovery by 50% of children within 10 days and 90% within 25 days. 7 However, some of the information used 7 was 35–50 years old, from a time when public health standards (eg, housing) were very different. Children should be reassessed within the expected timeframe of response to therapy.Ī systematic review on the natural history of acute cough in children aged 0–4 years in primary care found that, although most children’s conditions improve with time, 5%–10% of children develop bronchitis and/or pneumonia. Because of the favourable natural history of cough, a “positive” response in medication trials should not be assumed to be due to the medication. Treatment for chronic cough should be based on aetiology. Over-the-counter and prescription medications are ineffective for the symptomatic relief of acute cough. Isolated chronic cough in children is rarely asthma, and the term “cough variant asthma” should not be used. Most children with acute cough are likely to have an uncomplicated viral acute respiratory tract infection, but the possibility of a more serious problem, especially aspiration of foreign material, should always be considered. The aetiology and management approach for cough in children differs greatly to that in adults, so the empirical approach commonly used in adults is unsuitable for children.Ĭlinical evaluation of cough in children should include an assessment of environmental factors, particularly tobacco smoke, parental concerns and expectations.
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