PURPOSE: To evaluate the etiology of chronic cough in children using a comprehensive pulmonary, gastrointestinal, allergy and immunology workup.
METHODS: Forty consecutive children (mean age 9.2 yr) with cough of >8 weeks duration underwent the workup. For inclusion the children had to have been born full-term, be neurodevelopmentally appropriate for age, with no cigarette smoke exposure, no preceding history of a febrile respiratory illness and no underlying cardiac illness. The workup included chest xray, bronchoscopy, pulmonary functions, methacholine challenge, sweat test, extended esophageal pH/impedance monitoring, allergy skin testing and immunoglobulin levels. In select cases upper endoscopy, barium swallow, antibodies to childhood vaccines, sinus CT scan, chest CT scan and alpha-1-antitrypsin phenotypes were assessed.
RESULTS: The workup of these children (n=40) revealed the following findings: allergy/postnasal drip syndrome (n=9, 22.5%); gastroesophageal reflux disease (n=11, 27.5%); asthma (n=3, 7.5%); cough variant asthma (n=2, 5%); infection (n=2, 5%); allergy and asthma (n=6, 15%); allergy and reflux (n=2, 5%); aspiration (n=1, 2.5%). In 4 children (10%) all the tests were normal.
CONCLUSION: In 90% of selected children with chronic cough allergy, reflux and asthma are likely to account for the underlying symptoms.
CLINICAL IMPLICATIONS: In situations where facilities for extensive workup of chronic cough are not available, an initial stepwise approach to treating allergy, reflux and asthma has the potential for alleviating symptoms in most of these children. The remaining children could be referred to subspecialists.
DISCLOSURE: D. Edell, No Financial Disclosure Information; No Product/Research Disclosure Information