Chronic or recurrent cough in children. Is it asthma?

摘要

Chronic or recurrent cough is extremely common in young children and the management of cough during childhood constitutes a diagnostic and therapeutic challenge for the general practitioner and the pulmonary specialist. The differential diagnosis encompasses a wide range of pathology, however in most instances clinical and laboratory investigations do not identify a specific cause. Usually the pressing question to the clinician is whether this common symptom is an expression of asthma (cough variant asthma). Recent epidemiological, clinical and laboratory evidence suggests that cough without wheeze most likely is not asthma. Cough and bronchoconstriction are probably mediated via two separate pathways that may be activated simultaneously or separately and can be selectively inhibited. There is little room for non-etiologic pharmacological treatment of cough. The present review discusses the definition, epidemiology, diagnostic approach and treatment of chronic and recurrent cough in children. The complex relationship of cough, bronchial hyperreactivity, atopy and asthma are also reviewed and the need for thoughtful dispensing of anti-asthma medication in cough that is not accompanied by other characteristics of asthma is highlighted