Abstract
Pediatric cough-related issues, like most other conditions in particularly young children, share similarities but also have substantial important differences with adults. These can be understood from physiologically based domains simplified to (1) cough-specific, (2) general respiratory, (3) other direct systems such as the immune system, and (4) other general physiology. Among other reasons, these result in observed differences in etiology, management, and measurement of response between children and adults. For example, while empirical therapy for chronic cough is widely advocated for adults, it is not advocated for children. Indeed, there is some evidence that an empirical approach is potentially harmful; this is related to the use of medications and the delay in obtaining a correct diagnosis such as missed foreign body aspiration.
Similar content being viewed by others
References
Smyth RL (2001) Research with children. BMJ 322:1377–1378
Sinaiko AR, Daniels SR (2001) The use of short-acting nefedipine in children with hypertension: another example of the need for comprehensive drug testing in children. J Paediatr 139:7–9
Couriel J (1998) Infection in children. In: Ellis M (ed) Infectious diseases of the respiratory tract, 1st edn. Cambridge University Press, Cambridge, pp 406–429
Phelan PD, Olinsky A, Oswald H (1995) Asthma: classification, clinical patterns and natural history. Baillieres Clin Paediatr 3:307–318
Reed CE (1999) The natural history of asthma in adults: the problem of irreversibility. J Allergy Clin Immunol 103:539–547
Chang AB, Glomb WB (2006) Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest 129:260S–283S
Shields MD, Bush A, Everard ML, McKenzie SA, Primhak R (2008) British Thoracic Society guidelines recommendations for the assessment and management of cough in children. Thorax 63:iii1–iii15
Chang AB (2009) Cough. Pediatr Clin North Am 56:19–31
Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis S, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM (2006) Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 129:1S–23S
Vernacchio L, Kelly JP, Kaufman DW, Mitchell AA (2008) Cough and cold medication use by US children, 1999–2006: results from the Slone survey. Pediatrics 122:e323–e329
Chang AB (1999) State of the art: cough, cough receptors, and asthma in children. Pediatr Pulmonol 28:59–70
Faniran AO, Peat JK, Woolcock AJ (1998) Persistent cough: is it asthma? Arch Dis Child 79:411–414
Thomson F, Masters IB, Chang AB (2002) Persistent cough in children—overuse of medications. J Paediatr Child Health 38:578–581
Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB (2006) Evaluation and outcome of young children with chronic cough. Chest 129:1132–1141
Marchant JM, Newcombe PA, Juniper EF, Sheffield JK, Stathis SL, Chang AB (2008) What is the burden of chronic cough for families? Chest 134:303–309
Cornford CS, Morgan M, Ridsdale L (1993) Why do mothers consult when their children cough? Fam Pract 10:193–196
Davies MJ, Cane RS, Ranganathan SC, McKenzie SA (1998) Cough, wheeze and sleep. Arch Dis Child 79:465
Dicpinigaitis PV, Tso R, Banauch G (2006) Prevalence of depressive symptoms among patients with chronic cough. Chest 130:1839–1843
Ludviksdottir D, Bjornsson E, Janson C, Boman G (1996) Habitual coughing and its associations with asthma, anxiety, and gastroesophageal reflux. Chest 109:1262–1268
McGarvey LP, Carton C, Gamble LA, Heaney LG, Shepherd R, Ennis M, MacMahon J (2006) Prevalence of psychomorbidity among patients with chronic cough. Cough 2:4
French CT, Irwin RS, Fletcher KE, Adams TM (2002) Evaluation of a cough-specific quality-of-life questionnaire. Chest 121:1123–1131
Taussig LM, Smith SM, Blumenfeld R (1981) Chronic bronchitis in childhood: what is it? Pediatrics 67:1–5
Chernick V, Boat TF (1998) Kendig’s disorders of the respiratory tract in children. W.B. Saunders, Philadelphia
Brightling CE (2006) Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines. Chest 129:116S–121S
Fitch PS, Brown V, Schock BC, Taylor R, Ennis M, Shields MD (2000) Chronic cough in children: bronchoalveolar lavage findings. Eur Respir J 16:1109–1114
Marchant JM, Gibson PG, Grissell TV, Timmins NL, Masters IB, Chang AB (2008) Prospective assessment of protracted bacterial bronchitis: airway inflammation and innate immune activation. Pediatr Pulmonol 43:1092–1099
Chang AB, Redding GJ, Everard ML (2008) Chronic wet cough: protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 43:519–531
Chang AB, Phelan PD, Sawyer SM, Del Brocco S, Robertson CF (1997) Cough sensitivity in children with asthma, recurrent cough, and cystic fibrosis. Arch Dis Child 77:331–334
Varechova S, Plevkova J, Hanacek J, Tatar M (2008) Role of gender and pubertal stage on cough sensitivity in childhood and adolescence. J Physiol Pharmacol 59(Suppl 6):719–726
Kastelik JA, Thompson RH, Aziz I, Ojoo JC, Redington AE, Morice AH (2002) Sex-related differences in cough reflex sensitivity in patients with chronic cough. Am J Respir Crit Care Med 166:961–964
Chang AB, Widdicombe JG (2006) Cough throughout life: children, adults and the senile. Pulm Pharmacol Ther 20:371–382
Widdicombe JG (1977) Studies on afferent airway innervation. Am Rev Respir Dis 115:99–105
Undem BJ, Carr MJ, Kollarik M (2002) Physiology and plasticity of putative cough fibres in the guinea pig. Pulm Pharmacol Ther 15:193–198
Stiles J (2009) Neural plasticity and cognitive development. Dev Neuropsychol 18:237–272
Widdicombe J, Eccles R, Fontana G (2006) Supramedullary influences on cough. Respir Physiol Neurobiol 152:320–328
Everard M (2007) New respect for old conditions. Pediatr Pulmonol 42:400–402
Marchant JM, Masters IB, Taylor SM, Chang AB (2006) Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax 61:694–698
Mello CJ, Irwin RS, Curley FJ (1996) Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med 156:997–1003
Tulic MK, Fiset PO, Manuokion JJ, Frankiel S, Lavigne F, Eidelman DH, Hamid Q (2004) Roll of toll-like receptor 4 in protection by bacterial lipopolysaccharide in the nasal mucosa of children but not adults. Lancet 363:1689–1698
Leder K, Sinclair MI, Mitakakis TZ, Hellard ME, Forbes A (2003) A community-based study of respiratory episodes in Melbourne, Australia. Aust N Z J Public Health 27:399–404
Ladics GS, Chapin RE, Hastings KL, Holsapple MP, Makris SL, Sheets LP, Woolhiser MR, Burns-Naas LA (2005) Developmental toxicology evaluations—issues with including neurotoxicology and immunotoxicology assessments in reproductive toxicology studies. Toxicol Sci 88:24–29
Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–231
Chang AB (2005) Cough: are children really different to adults? Cough 1:7
Chang AB, Phelan PD, Roberts RGD, Robertson CF (1996) Capsaicin cough receptor sensitivity test in children. Eur Respir J 9:2220–2223
Newcombe PA, Sheffield JK, Juniper EF, Halstead RA, Masters IB, Chang AB (2008) Development of a parent-proxy quality-of-life chronic cough-specific questionnaire: clinical impact vs psychometric evaluations. Chest 133:386–395
Chang AB, Phelan PD, Robertson CF, Roberts RDG, Sawyer SM (2003) Relationship between measurements of cough severity. Arch Dis Child 88:57–60
Chang AB, Phelan PD, Carlin J, Sawyer SM, Robertson CF (1998) Randomised controlled trial of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child 79:6–11
Chang AB, Phelan PD, Robertson CF, Newman RG, Sawyer SM (2001) Frequency and perception of cough severity. J Paediatr Child Health 37:142–145
Decalmer SC, Webster D, Kelsall AA, McGuinness K, Woodcock AA, Smith JA (2007) Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring? Thorax 62:329–334
Hay AD, Wilson AD (2002) The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review. Br J Gen Pract 52:401–409
Ayres JG, Noah ND, Fleming DM (1993) Incidence of episodes of acute asthma and acute bronchitis in general practice 1976–87. Br J Gen Pract 43:361–364
Butler CC, Kinnersley P, Hood K, Robling M, Prout H, Rollnick S, Houston H (2003) Clinical course of acute infection of the upper respiratory tract in children: cohort study. BMJ 327:1088–1089
Deerojanawong J, Chang AB, Eng PA, Robertson CF, Kemp AS (1997) Pulmonary diseases in children with severe combined immune deficiency and DiGeorge syndrome. Pediatr Pulmonol 24:324–330
Campbell H, Byass P, Lamont AC, Forgie IM, O’Neill KP, Lloyd EN, Greenwood BM (1989) Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children. Lancet 1:297–299
Mulholland EK, Simoes EA, Costales MO, McGrath EJ, Manalac EM, Gove S (1992) Standardized diagnosis of pneumonia in developing countries. Pediatr Infect Dis J 11:77–81
Fatmi Z, White F (2002) A comparison of ‘cough and cold’ and pneumonia: risk factors for pneumonia in children under 5 years revisited. Int J Infect Dis 6:294–301
British Thoracic Society (2002) Guidelines for the management of community acquired pneumonia in childhood. Thorax 57(Suppl 1):I1–I24
Jadavji T, Law B, Lebel MH, Kennedy WA, Gold R, Wang EE (1997) A practical guide for the diagnosis and treatment of pediatric pneumonia. CMAJ 156:S703–S711
Nelson JD (2000) Community-acquired pneumonia in children: guidelines for treatment. Pediatr Infect Dis J 19:251–253
Cataneo AJ, Reibscheid SM, Ruiz RL Jr, Ferrari GF (1997) Foreign body in the tracheobronchial tree. Clin Pediatr (Phila) 36:701–706
Oguz F, Citak A, Unuvar E, Sidal M (2000) Airway foreign bodies in childhood. Int J Pediatr Otorhinolaryngol 52:11–16
Mu L, He P, Sun D (1991) Inhalation of foreign bodies in Chinese children: a review of 400 cases. Laryngoscope 101:657–660
Raman TS, Mathew S, Ravikumar, Garcha PS (1998) Atelectasis in children. Indian Pediatr 35:429–435
Nicolai T (1999) Air pollution and respiratory disease in children: what is the clinically relevant impact? Pediatr Pulmonol Suppl 18:9–13
Iacuone JJ, Wong KY, Bove KE, Lampkin BC (1977) Acute respiratory illness in children with acute lymphoblastic leukemia. J Pediatr 90:915–919
Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM Jr (2007) Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med 161:1140–1146
Schroeder K, Fahey T (2002) Should we advise parents to administer over the counter cough medicines for acute cough? Systematic review of randomised controlled trials. Arch Dis Child 86:170–175
Schroeder K, Fahey T (2004) Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev 4:CD001831
Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, Dilworth DA, Berlin CM Jr (2004) Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics 114:e85–e90
Gunn VL, Taha SH, Liebelt EL, Serwint JR (2001) Toxicity of over-the-counter cough and cold medications. Pediatrics 108:E52
Del Mar C, Glasziou P (2002) Upper respiratory tract infection. Clin Evid 8:1583–1591
Salzberg R, Giambonini S, Maurizio M, Roulet D, Zahn J, Monti T (1993) A double-blind comparison of nimesulide and mefenamic acid in the treatment of acute upper respiratory tract infections in children. Drugs 46(Suppl 1):208–211
Bernard DW, Goepp JG, Duggan AK, Serwint JR, Rowe PC (1999) Is oral albuterol effective for acute cough in non-asthmatic children? Acta Paediatr 88:465–467
Smucny JJ, Flynn CA, Becker LA, Glazier RH (2001) Are beta2-agonists effective treatment for acute bronchitis or acute cough in patients without underlying pulmonary disease? A systematic review. J Fam Pract 50:945–951
Dowell SF, Schwartz B, Phillips WR (1998) Appropriate use of antibiotics for URIs in children: part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. Am Fam Physician 58:1113–1123
Holscher B, Heinrich J, Jacob B, Ritz B, Wichmann HE (2000) Gas cooking, respiratory health and white blood cell counts in children. Int J Hyg Environ Health 203:29–37
Jaakkola JJ, Jaakkola MS (2002) Effects of environmental tobacco smoke on the respiratory health of children. Scand J Work Environ Health 28(Suppl 2):71–83
Hermann C, Westergaard T, Pedersen BV, Wohlfahrt J, Host A, Melbye M (2005) A comparison of risk factors for wheeze and recurrent cough in preschool children. Am J Epidemiol 162:345–350
Asilsoy S, Bayram E, Agin H, Apa H, Can D, Gulle S, Altinoz S (2008) Evaluation of chronic cough in children. Chest 134:1122–1128
American Academy of Pediatrics (2001) Tobacco’s toll: implications for the pediatrician. Pediatrics 107:794–798
Cockburn J, Pit S (1997) Prescribing behaviour in clinical practice: patients’ expectations and doctors’ perceptions of patients’ expectations questionnaire study. BMJ 315:520–523
Little P, Gould C, Williamson I, Warner G, Gantley M, Kinmonth AL (1997) Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ 315:350–352
Pandolfini C, Impicciatore P, Bonati M (2000) Parents on the web: risks for quality management of cough in children. Pediatrics 105:e1