Professional Documents
Culture Documents
Case
The mother of a 9 year old boy brings her son to the office because of a cough that has
persisted for a month. The child has no fever, no respiratory distress, and appears to engage
in normal activities. The school is concerned about the child's cough and will not allow him
back to school until the problem resolves. How would you evaluate this boy?
A chronic cough is defined as a cough that persists for more than 3-4 weeks. In most
instances the process is self limited.
1. Infection
a. RSV
b. Pertussis
c. Chlamydia
d. Tuberculosis
2. Gastroesophogeal reflux-aspiration or vagal response. May have chemical or
inflammatory reaction.
3. Reactive airway disease-associated with smoke exposure, URIs, cold air, family
history of atopy
4. Cystic fibrosis
5. Congenital anomalies
a. Vascular rings
b. TEF
c. Sequestration of the lung
1. Recurrent URIs. Children may have up to 10 viral URIs during a year and overlaps
may appear to be "chronic". This is pertinent in daycare attendees.
2. Reactive airway disease
3. Foreign body aspiration
4. GER
5. Pollutant exposure
6. TB
7. Suppurative Lung Disease- often will be growing poorly and cough productive
a. CF
b. bronchiectasis
School Age Children
1. Sinusitis
2. RAD
3. Smoking
4. Psychogenic- usually the cough is bizarre sounding( honking, barking, croupy). The
child is often not disturbed by the cough although others around are. Often disappears
when asleep.
5. Suppurative lung disease
Physical Exam
1. Growth
2. Respiratory rate
3. Cardiac Exam
4. Clubbing and Cyanosis
5. Chest exam
6. Evidence of atopic disease
Diagnosis- Most often chronic coughs are caused by self-limited common processes.
1. Chest xray
2. Sweat Chloride if indicated by history and exam.
3. GER evaluation
4. PPD
5. Evaluation for foreign body if history consistent with the possibility
6. Trial of bronchodilators and course of oral steroids
7. Skin testing
Management
References