Infection top cause of chronic cough in children

Last Updated: 2015-03-27

By David Douglas

NEW YORK (Reuters Health) - Just three causes account for more than 80% of coughs lasting more than four weeks in children referred to otolaryngologists, according to a review of data from a major health center.

Those etiologies - infection, airway hyperreactivity, and gastroesophageal reflux - "should be high in differential diagnosis when evaluating these patients," Dr. Samanatha Anne told Reuters Health by email.

"The paper gives otolaryngologists a possible pathway in management of chronic cough in children based on the presenting symptoms and diagnostic testing done when they present to a otolaryngology clinic initially," she said.

In a March 19 online paper in JAMA Otolaryngology-Head & Neck Surgery, Dr. Anne of the Cleveland Clinic and colleagues note that otolaryngologists' populations differ from those seen in primary care. They also point out that prevalence of chronic cough in school children runs as high as 10.4%.

For this analysis, the team had data on 58 pediatric patients presenting with chronic cough at two otolaryngology clinics between 2009 and 2013.

The most common cause was infection, accounting for 34%, followed by airway hyperreactivity, including asthma (24%) and gastroesophageal reflux disease (also 24%).

Overall, 48 patients (83%) had an initial response to treatment; the remaining 10 required further evaluation. Most had pertinent findings on chest x-rays and were referred to a pulmonologist; all were ultimately diagnosed with asthma.

"We would advocate an early referral to a pulmonologist and evaluation with chest radiography if improvement is not seen within four weeks of initiation of treatment," the authors write.

SOURCE: http://bit.ly/1Nmcjwq

JAMA Otolaryngol Head Neck Surg 2015.