The Cough “That Won’t Quit”

by Tariq M. Khan, MD, FAAP

Although there are numerous causes of a chronic cough, and the list is too long to list here, the one we would like to talk about today is asthma in children and adolescents.

There is a saying in the medical community that unless you suspect asthma, you are not going to diagnose it. As medical professionals providing health care to kids of all ages, one of the most common reasons doctor’s see children is for a cough. This occurs more so in the fall and winter months. We know that most coughs are usually benign and related to common seasonal viruses and occasionally seasonal nasal allergies. They will subside, in time, on their own, and not much is needed in the form of formal treatment. However, there are coughs that will linger, and despite patience and time, they will not resolve. These children will present to their doctor’s office several times over this period, which can be quite frustrating for families

One of the common underlying themes with these chronic coughs can be asthma. According to the World Health Organization, pediatric asthma is the most common chronic disease condition in children.

Asthma can have several varieties, but the most common type results in chronic inflammation of respiratory tubes or passages resulting in excessive mucous and plugging of airways causing coughing, wheezing, and difficulty breathing

There are types of asthma where there may not be much mucous production, and the presentation could be shortness of breath, chronic cough, and occasionally chest pain. Most pediatric chest pain is usually not serious and not associated with heart disease. Most is muscular in nature but if persistent and there are no underlying cardiac issues, asthma should be suspected. There is usually a family history of asthma or nasal allergies in parents, siblings, or close family members

Asthma can be diagnosed at any age. In infants and toddlers, a diagnosis is usually based on history and ruling out other causes of chronic cough. Older school age children can be set up for a “breathing test,” or pulmonary function test, to help with diagnosis. Once a diagnosis is made, then the treatment depends on the type and severity of asthma. Treatment can range from occasional use of medication when symptoms occur to a daily medication.  Most children will usually outgrow their asthma, or symptoms will get less frequent as they get older. Parents can help by making sure medication is given as prescribed, and regular follow ups are scheduled with a health care provider

Families can help keep these children healthy and out of emergency rooms by avoiding triggering factors, such as outdoor and indoor allergens, and irritants, such as cigarette smoke

As always, this is for general informational purposes. Parents and families should contact their health care provider for more details.