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NEW YORK (Reuters Health) - In children with a cough that lasts more than 8 weeks, the most likely causes are allergy, reflux, and asthma, according to a report in the September issue of Chest.
"In many cases, the etiology of chronic cough is clearly declared in a patient's history or on physical examination findings," Dr. Vikram Khoshoo, of West Jefferson Medical Center, Marrero, Louisiana, and colleagues write. "In other cases...the diagnosis remains clinically challenging."
For their current study, the researchers evaluated 40 children between the ages of 5 and 12 who had chronic cough (> 8 weeks duration) with no obvious cause. The mean duration of cough was 18 weeks. Only four children had a productive cough.
After a multispecialty workup that included pulmonary, gastrointestinal, allergy, immunology, and otorhinolaryngology testing, at least one potentially causative factor was identified in 36 children (90%). Tests were completely normal in only 4 children (10%).
The cough was attributed to gastroesophageal reflux disease in 27.5% of the children studied, to allergy in 22.5%, to asthma in 12.5%, to infection in 5%, to aspiration in 2.5%, and to multiple etiologies in 20%.
Nocturnal cough was more common in children with allergy and asthma than in those with reflux, the authors note.
Children with a positive test result were treated accordingly, and a significant improvement in cough was observed after 8 weeks of treatment.
"Based on current recommendations of the American College of Chest Physicians, it would seem to the primary care physicians that treatment with antibiotics would be the preferred empiric treatment of chronic cough in children," the researchers point out.
"Based on our data, it seems that we may have to rethink" these recommendations, they add.
The next step is "to design and evaluate intervention studies in children with chronic cough to develop cost-effective practice guidelines for primary care physicians," Dr. Khoshoo and colleagues conclude.
Chest 2009;136:811-815.
