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Management of chronic non-specific cough in childhood: an evidence-based review
  1. Atul Gupta1,
  2. Michael McKean1,
  3. Anne B Chang2
  1. 1Paediatric Respiratory Unit, Freeman Hospital, Newcastle upon Tyne, UK
  2. 2Department of Respiratory Medicine, Royal Children’s Hospital, Brisbane, Queensland, Australia; Menzies School of Health Research, Darwin, NT, Australia
  1. For correspondence:
    Dr A Gupta
    Paediatric respiratory Unit, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK; atulgupta{at}doctors.org.uk

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Cough and sneezes spread diseases … so why do we have to cough? Cough is an important protective reflex enabling us to clear secretions aspirated into the airway. We understand many of the causes of acute and chronic cough in children, but for some children cough persists without any obvious reasons as to why. In the past it has often been assumed to be due to childhood asthma but increasingly chronic “non-specific cough” of childhood is recognised as a separate entity albeit without any identifiable cause. Paediatricians are frequently faced with a child with chronic non-specific cough. How then should these children be managed? This article focuses on the approach to assessment and investigations of chronic non-specific cough in children and includes a systematic review of common therapies.

EPIDEMIOLOGY AND MORBIDITY OF COUGH ON THE PARENTS/CHILDREN

Cough is perhaps one of the commonest symptoms in childhood and, although most acute cough is related to viral infections, there are a great number of differential diagnoses (table 1) to consider when cough frequency or severity are abnormal. Questionnaire data which rely on the subjective impression of parents suggest that up to 10% of preschool and early school aged children have chronic cough without wheeze at some time.1–3

View this table:
Table 1

 Differential diagnosis of chronic cough in children

It is unknown whether the primary stimulus for chronic cough in many children is identical to that for acute cough. Further, it is unknown why the cough associated with common acute viral upper respiratory tract infection resolves in most, yet persists in a significant minority. It may be that both specific virus and host factors play a role.

In chronic non-specific cough, the aetiology is ill defined and it is suspected that the majority are related to post viral cough and/or increased cough receptor sensitivity.4,5 Wright in 1996 identified a cohort of …

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