Approach to a Child with Chronic cough : ACCP guidelines

Cough is one of the most common presenting complain in children at Out-patient. Cough may be just a benign protective phenomenon , but at times it become troublesome . Cause of Cough Should be sought for even outside the respiratory system, like ears,abdomen etc.

CHRONIC COUGH

Cough  lasting for 4 weeks or more -CHEST January 2006

1.Inflammatory disorder of airway
Asthma & Loeffler’s syndrome, Tropical eosinophilia, hypersensitivity pneumonitis.
Infection- viral, bacterial, chlamydia, mycoplasma, tuberculosis, fungal, parasitic etc.
Inhalation of environmental irritant- smoke, dust, tobacco.

2.Suppurative lung disease
Bronchiectasis, cystic fibrosis
Foreign body retained in the bronchi
Immune deficiency, dysmobility of cilia

3.Anatomic lesions
Vascular ring compressing airway; tracheal stenosis; tracheo-esophageal fistula; congenital malformations; sequestrated lobe; laryngeal web, cyst or stenosis; vocal cord paralysis; laryngotracheobronchomalacia

4.Psychogenic- habit cough

5.Post nasal discharge, sinusitis

6.Gastroesophageal reflux disease (chronic aspiration)

7.Interstitial lung disease

8.Pressure to trachea/main bronchus enlarged LN, cysts,& tumors in mediastinum. anomalous Lt. pulmonary artery
Pulmonary hemosiderosis

9.Cardiac causes
a. Pulmonary edema
b. Congestive cardiac failure
c. Pericarditis
d. Myocarditis
e. congenital heart disease

10.Drugs
a. ACE inhibitor
b. Beta antagonists

11. Abdominal Causes
a.Diaphragmatic hernia
b.eventeration of diaphragm
c. intra-abdominal masses
d.Massive ascites

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One Response
  1. August 31, 2011

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