INTRODUCTION

All children experience head colds and many consult their doctor because of associated coughing.1 Cough with colds remedies are among the most commonly used medications in children in Western societies, despite evidence suggesting ineffectiveness of medication to treat cough as a symptom. The aetiology of coughing in children will cover a wide spectrum of respiratory disorders, and finding and treating the underlying cause is important.

Community-based surveys show that parental-reported cough as an isolated symptom has a high prevalence.2 3 Reported cough without colds has a prevalence of 28% in boys and 30% in girls.4

The recognised underdiagnosis of asthma led to the importance of cough as a symptom being stressed. However, there is increasing evidence that children are inappropriately treated for asthma based on cough as the sole symptom.5 6

Coughing in children can be distressing and has a major impact on a child’s sleep, school performance and ability to play. It may similarly disturb other family members’ sleep and be disruptive for school teachers. Considerable parental anxiety is generated in families with a child with problem coughing.7 8

The reported severity of a child’s cough may relate to how it affects parents and teachers. Recent evidence has highlighted that parental reporting of the frequency and severity of a child’s cough is unreliable compared with objective measures, and this is especially true for nocturnal cough. Indeed, it has been suggested that cough as reported in surveys and as a clinical trial outcome should either not be used or be interpreted with caution.9^–12 This limits the certainty that can be placed on most of the published literature that has not used objective cough measurements.

The need and purpose of BTS recommendations on the management of cough

These guidelines are needed because childhood coughing is a common problem that generates much anxiety, has numerous different …