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Original Investigation
May 2015

Chronic Cough in Children

Author Affiliations
  • 1Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 2Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
  • 3Department of Pediatric Otolaryngology, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2015;141(5):417-423. doi:10.1001/jamaoto.2015.0257

Importance  Chronic cough is a common complaint among pediatric patients, but little information exists on the types of diagnoses in these patients and therapeutic outcomes.

Objective  To characterize pediatric patients with chronic cough presenting to otolaryngology clinics, identify common causes and treatments, and evaluate therapeutic outcomes.

Design, Setting, and Participants  In this retrospective analysis, all medical records for pediatric patients seen at 2 otolaryngology clinics at a single tertiary care academic medical center from January 2009 through June 2013 were searched for relevant diagnostic codes. Patients younger than 18 years presenting with chronic cough (cough of >4 weeks’ duration) were selected for study; 58 patients met the inclusion criteria and were selected for analysis.

Interventions  Each patient was evaluated by the clinician via history, physical examination, and various tests and procedures, depending on the individual case, including flexible laryngoscopy, imaging tests, and/or airway evaluations. Each patient underwent treatment based on the working diagnosis.

Main Outcomes and Measures  Primary outcomes included final diagnosis, response to treatment (as indicated by resolution of cough after initial therapy), and diagnostic workup undergone.

Results  Among the 58 included patients, the 3 most common diagnoses were related to infection (n = 23; 34%), airway hyperreactivity (n = 14; 24%), or gastroesophageal reflux disease (n = 14; 24%). Initial response to treatment was observed in 83% of patients (n = 48), while the remaining 17% (n = 10) required further evaluation. All 10 patients for whom initial treatment failed (100%) had a diagnosis involving airway hyperreactivity (P < .001). In addition, chest radiography was more likely to be ordered (odds ratio [OR], 16.4; 95% CI, 1.91-140.8; P = .002) and to contain pertinent positive findings (OR, 12.8; 95% CI, 1.15-142.6; P = .04) in patients for whom treatment failed.

Conclusions and Relevance  Chronic cough in the pediatric otolaryngology setting differs from the typical presentation in the primary care setting. The top 3 causes encountered by the practicing otolaryngologist in a pediatric patient are infection, airway hyperreactivity, and gastroesophageal reflux disease. If initial otolaryngologic treatment fails, chest radiography and early pulmonary consult are recommended.