Diagnosing chronic cough in children

Problem coughing is common in children and can be produced by almost all the respiratory disorders that affect them. Rather than applying a comprehensive battery of tests to all children, most doctors use clinical pointers in the history and examination to determine the need for and targeting of investigations. Indeed, experienced clinicians usually use more than one single feature or diagnostic test and bring together bits of the history, clinical examination, and selective investigative tests to arrive at a diagnosis. Typical clinical cues recommended to be used in evaluating cough include (1) age of symptom onset, (2) quality of the cough, (3) triggers, periodicity and timing of cough, and (4) associated features such as wheezing.¹

Recent evidence suggests that parents do not report the frequency or severity of cough accurately.^2,3 However, work from Professor Chang’s unit has shown that parental reporting of wet versus dry cough is likely to be accurate.⁴ Most of the clinical characteristics or pointers used to predict specific diseases causing cough in children have not been rigorously subjected to assessment as would be required for a diagnostic test⁵ and, typically, historical …