Cough
DR.M.ABBAS.SUBHANI
MBBS DCH
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Cough is a very common symptom. Majority of the
patients suffering from cough have minor harmless and self limiting illness. This fact is
known to the family members of the children, that is why, they usually do not consult the
physicians for cough and manage the child, with cough syrups. Cough syrups are easily
available, they are not very costly fortunately majority of the cough syrups do not have
significant side effects.
Consultation for the cough is generally suggestive of the facts that
- Cough is significant and the used cough syrups have not achieved the desired effect
- The attendants of the child are too worried for the child ( this may be due to their
past experience or the generation of fears by others)
Following considerations are important in the management of cough
- Is the cough significant?
- What is the likely cause? Cough without findings
- Need of investigations
- Treatment needed
- Is it serious? Education of the attendants
The cough is considered significant if
- it disturbs feeding, sleep and routine activities
- it is associated with vomiting, exhaustion, fainting, wheezing, stridor, breathlessness,
pain in chest and / or blood in sputum
- The intensity does not decreases with conventional cough syrups or it persists for more
than one week
- Cough below the age of 3 months. Cough reflex does not develop before this age.
The likely cause
Cough may be the only complaint, without any observed finding. Keep the possibility of
following conditions
Cough
without finding
- Post nasal discharge, the cough usually starts on lying down in the early night
- Asthma, the cough may not be associated with wheezing, it usually occurs in late night
- Prodromal stage of some illnesses, e.g. measles
- Psychogenic, cough is not observed during sleep, and it does not disturb sleep, speech
or feeding
- Some patients of whooping cough
- Early stage of tuberculosis
|
Cough with
wheeze
- Bronchiolitis
- Asthma
- Brochitis
- Loeffler’s syndrome
- Tropical pulmonary eosinophilia
- Foreign body
- brochopneumonia
|
Cough with
stridor
- Viral or spasmodic croup
- Epiglottitis
- Foreign body
- Very rarely asthma
|
Need of investigations
All coughs do not need investigation, only the significant coughs are to be
investigated with the help of laboratory support. Following investigations may be done,
but they may not be practicable.
- Blood counts are not much helpful in the identification of bacterial illnesses
- X ray chest may be helpful for the detection of brochiolitis (air trapping)
brochopneumonia, foreign body and tuberculosis
- Sputum microscopy and culture
- Tuberculine test
- Spirometery is easy to use. Its use before and after bronchodilator therapy is quite
helpful in the diagnosis of reversible bronchospasm (asthma). But it not popular with
majority of the primary care physicians in our country.
- Absolute eosinophils count. Ideally this should be advised in all wheezy patients
- Endoscopic examination respiratory tract if foreign body is suspected. This not be
delayed as delay may be fatal.
Treatment needed
The child is to be nursed in a well-ventilated room. Overheating of the room and
wrapping of the child in warm clothes may lead to dryness of secretions, and may aggravate
the cough. Adequate hydration is to be maintained to avoid drying of secretions. Plenty of
oral fluids are to be used
The treatment depends upon the cause. Commonly used drugs are
- Dextromethorphan is effective cough sedative, it is not habit forming
- Bronchodilators are the best antitussives for asthma. Both beta agonists and xanthines
are helpful in the mucociliary transport of the secretions. Salbutamol is helpful in the
control of cough in pertussis.
- A short course of steroids is helpful in reduction of the edema and inflammation in the
respiratory tract.
- Diethyl carbamazine if tropical pulmonary eosinophilia is suspected. Loeffler syndrome
is self-limiting. Antihelminthic drugs are not effective in the migratory phase.
Education of the attendants
Two aspects are very important in the education of attendants / parents, identification
for the need of urgent consultation, and what they should not do.
The attendants should be instructed not to delay the consultation if they observe
- Breathlessness or grunting or pain in chest or broken speech (the child is not able to
complete sentences or words)
- Color changes (bluish discoloration of lips and nails or skin)
- Stidor or wheezing at rest
- Choking during feeds
- Persistent vomiting
- Blood in sputum
- Worsening condition of the child
They (attendants) also need to be instructed not to
Wrap the child too heavily or over heat the room, these practices may dry up the
secretions and aggravate the cough.
Not to use tincture benzoin, vicks or chest balms, their benefit is not proven and some
of the children may be hypersensitive to these drugs, due to this reason cough may become
worse.