Cough Flashcards
(23 cards)
Key points- cough paeds
The most common cause of cough is an upper respiratory tract infection (usually viral in nature)
Investigations and treatment are rarely required for well children with a short history of cough
Children who have a persistent daily cough lasting >4 weeks should be assessed and investigated with a CXR and spirometry (if able), with consideration given to further investigations and management
What features of a cough in children does not warrant further ix
For healthy children with a short history of cough (<4 weeks) and no red flags, further investigation and management is not required
Acute cough paeds def
Lasts up to 2 weeks
Protracted acute cough paeds def
Daily cough lasting 2-4 weeks
Chronic cough paeds def
Daily cough lasting >4weeks
MCC of cough in children
Viral URTI or post infectious cough
Common causes of acute, dry cough -paeds
Respiratory infections (most commonly viral)
Foreign body inhalation
Exposures (eg smoking, vaping, irritants, medications)
Common causes of acute wet cough in children
Resp infections (viral)
Common causes of dry chronic cough in paeds
Respiratory infection (post-infectious cough, including pertussis)
Asthma
Habit cough and somatic cough disorder
Congenital airway abnormalities (eg tracheo/bronchomalacia, vascular rings, tracheo-oesophageal fistula)
Interstitial lung disease
Common causes of chronic wet cough in children
Protracted bacterial bronchitis (PBB)
Recurrent aspiration (can be associated with neurodevelopmental disabilities, congenital airway abnormalities)
Chronic infection (tuberculosis, lung abscess, etc)
Foreign body inhalation
Bronchiectasis/chronic suppurative lung disease (due to post-infectious, CF, immunodeficiency, primary ciliary dyskinesia)
Chronic atelectasis (intrinsic or extrinsic airway obstruction)
Hx in cough in paeds
Feature on history Description (including specific conditions not to be missed in assessment of chronic cough)
Quality Wet or dry (listen to sound of wet cough here)
Duration Distinguish chronic cough from recurrent acute viral infections (fevers, coryza, daycare attendance)
Onset/triggers
Sudden onset without viral prodrome (or after choking episode) may suggest foreign body inhalation
Onset in early infancy may suggest aspiration, congenital airway abnormality or cystic fibrosis
Choking or coughing with feeding may suggest aspiration
Association with exercise, environment changes, smoke/pets/dust exposures may suggest asthma (and/or allergic rhinitis)
Frequency
Determine whether cough episodes occur occasionally or frequently through the day and/or night
Number of episodes of chronic wet cough in a year is important to identify children who may need further investigation for chronic suppurative lung disease (>3 episodes of PBB in 12-month period warrants referral/further investigation)
Timing Specific patterns (worsening or improving at certain times of the day) may suggest conditions such as GORD, post-nasal drip/sinusitis (worse when lying flat), asthma (tends to exacerbate at night, with exercise), somatic cough disorder (absent during sleep) or chronic suppurative lung disease (worse on waking)
Sputum Presence of haemoptysis, colour, consistency and volume
Type
Daily, persistent, wet, often in morning: protracted bacterial bronchitis (PBB), chronic suppurative lung disease, bronchiectasis
Paroxysmal: pertussis or foreign body
Staccato: suggestive of chlamydia (in infants)
Barking or seal-like (+/- stridor): croup
Dry +/- wheeze: asthma
Dry, honking, barking, distractible, suggestible: tic or somatic cough disorder
Underlying medical conditions Neurodevelopmental disorders, dysphagia, neuromuscular disorders, immunodeficiency, congenital cardiac disease
Family and social history
Infectious contacts
Travel history
Exposure to smoking or vaping (personal or passive)
Immunisation status
Family history of chronic lung disease, atopy, cystic fibrosis, tuberculosis
Examination in cough in peads
Fever, coryza or other signs of acute infection
Increased work of breathing, hypoxia, stridor, chest signs (wheeze, crackles, crepitations)
Faltering growth (or growth failure)
Signs of cardiac failure (oedema, hepatomegaly, heart murmur)
Signs of chronic suppurative lung disease/bronchiectasis (clubbing, poor growth, chest wall deformity)
ENT examination for signs of rhinosinusitis
Red flags for chronic cough in paeds
Shortness of breath (at rest or exertional)
Recurrent episodes of chronic or wet or productive cough
Recurrent pneumonia
Chest pain
Haemoptysis
Systemic symptoms (fever, weight loss, growth failure)
Neurodevelopmental abnormality
Feeding difficulties (including choking/vomiting)
Stridor and other respiratory noises
Abnormal clinical respiratory examination (eg crackles, digital clubbing)
Abnormal systemic examination (eg growth failure)
Abnormal chest x-ray
Abnormal lung function
Co-existing chronic disease (eg immunodeficiency, syndromes)
WHen is further assessment required for a children withcouugh
acutely unwell children (see sepsis, community acquired pneumonia, asthma, foreign body, pertussis, croup, bronchiolitis)
children with a persistent (chronic) cough for >4 weeks
specific cause of cough suspected on assessment
Mng of acute, non specific cough in children
Over the counter cough medicines and decongestants are not recommended due to lack of proven efficacy and potential safety risks
Empiric use of antibiotics, steroids, proton pump inhibitors and antihistamines are not recommended
Honey is often proposed as a treatment for cough, but there is no strong evidence supporting its effectiveness, and it carries risks such as infant botulism (in infants <12 months), dental caries and aspiration
Mng algorithim cough peads
https://www.rch.org.au/uploadedImages/Main/Content/clinicalguide/guideline_index/Cough-management.png
Features of protracted bacterial bronchitis
Most common cause of chronic wet cough in children. Children are otherwise well, with no alternative cause evident on history or examination and investigations (including chest x-ray, apart from perihilar thickening) are normal
Mng of protracted bacterial bronchitis
Extended course of antibiotics. Start with 2-week course of
Amoxicillin/clavulanic acid 22.5 mg/kg of amoxicillin component (max dose 875 mg) bd
Penicillin hypersensitivity: trimethoprim/sulfamethoxazole 4 mg/kg of trimethoprim component (max dose 160 mg) bd
If wet cough persists after 2 weeks, continue same antibiotic for a further 2 weeks
If wet cough persists after 4 weeks or child has had >3 PBB episodes/year, consider further investigations (as per suppurative lung disease) and referral to paediatrician and/or paediatric respiratory physician
Features of chronic suppurative lung disease, bronchiectasis in children
Chronic wet cough, which is unresponsive to PBB treatment, or frequently recurs when antibiotics ceased. Can also have recurrent pneumonia, abnormal chest x-ray, and suggestive examination findings (clubbing, growth failure, chest wall deformity)
mng ofchronic suppurative lung disease, bronchiectasis in children
FBE, serum immunoglobulins (IgM, A, G), chest x-ray, spirometry (if able), sweat test, sputum culture
Refer to paediatric respiratory physician for further assessment (including consideration of CT chest, bronchoscopy and bronchoalveolar lavage)
Specific treatment depends on underlying cause
Features of intersitial lung disease in children
Chronic (typically) dry cough. Diffuse inspiratory crepitations, tachypnoea, growth failure, hypoxia
features of somatic cough or tic disorder in chilren
Often honking, disappears when asleep or distracted. Repetitive throat clearing
When to refer child to paediatric resp doctor
Chronic wet cough and failure to respond to 4 weeks of appropriate antibiotics
Recurrent episodes of chronic wet cough (>3 episodes of PBB/year)
Chronic dry cough persisting >6 months and failure to respond to appropriate treatment (eg empiric trial of asthma treatment)
Assessment is suggestive of specific cough, or red flags are present
