Table 3 Patterns, causes and potential investigations of chronic or frequently recurrent cough in otherwise healthy children
PatternCausePotential investigations
Frequently recurring viral bronchitisEpisodic, frequent in winter, associated with “head colds”, may occur “back-to-back”Viral infectionsNone
Crowded living conditions, ETS and attendance in child care nurseryChest radiography
Examine during a period when symptom-free
Postviral coughTroublesome cough (day and night) following a respiratory infection and slowly resolving over next 2–3 monthsViral respiratory infections, Chlamydia and Mycoplasma infectionsNone, chest radiography, serology
Consider trial of asthma therapy (some mild asthmatics have prolonged recovery from each viral infection)
Pertussis and pertussis-like illnessTroublesome spasmodic cough after initial respiratory infection which slowly resolves over 3–6 months. Vomiting clear tenacious mucus. Older child may complain of difficulty catching breathBordetella pertussis, parapertussis, adenovirus, influenza, parainfluenzaNil
Chest radiograph, positive serology or culture may be helpful in reducing requirements for further investigation
Cough variant asthmaIsolated cough (no wheezing) due to asthma. Confidence in diagnosis increased when strong atopic background present and cough responds rapidly to anti-asthma medication but relapses when stoppedAsthmaNone, chest radiograph. Is airways obstruction present and reversible?
BHR or BDR tests,
Is there eosinophillic inflammation? Induced sputum, allergy tests, FeNO, response to asthma medication
Allergic rhinitis, postnasal drip and sinusitis – cough likely due to concomitant tracheobronchial inflammationNot fully accepted as a cause of cough. Cough when “head hits the pillow” or constant throat clearing by day. May have transverse nasal crease of “allergic salute”Causes of allergic rhinitisENT examination, often no investigations needed
Chest radiography, allergy tests
Response to antirhinitis treatment within 2 weeks
CT scan of sinuses
Psychogenic coughUsually an older child/adolescent(1) Tic-like “habit cough” persisting after head cold or during times of stress(2) Bizarre disruptive honking cough with child exhibiting “la belle indifference”. Cough goes away with concentration or sleepUnderlying stressIt is important to do investigations to assure the doctor and parent that no major disease is being missed. However, it is important not to keep performing futile investigations that may reinforce the underlying problem
Bizarre honking cough usually serving a purpose with some secondary gain
  • ETS, exposure to environmental tobacco smoke; FeNO, fractional exhaled nitric oxide concentration; BDR, bronchodilator responsiveness; BHR, bronchial hyperreactivity.