Etiology of chronic cough in a population of children referred to a pediatric pulmonologist.

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Chronic cough is a common complaint encountered by physicians who care for children. It is also a common reason for referral to a pulmonologist. Determining the cause of chronic cough, however, rarely requires specialized diagnostic procedures that are unavailable to the primary care physician. A computerized listing of new patients referred to a pediatric pulmonologist between July 1993 and June 1995 was reviewed. Of 299 patients examined as outpatients during this period, 95 were referred for chronic cough. The diagnosis and diagnostic procedures were examined to determine how frequently procedures available exclusively to subspecialists were necessary to determine the cause of chronic cough. Of the 95 patients who were examined for cough during the period studied, the diagnosis was made by history in 5, pulmonary function testing in 11, radiographic tests in 15, and a therapeutic trial in 58. In only 6 cases was the diagnosis made using tests unavailable to the primary care physician (5 bronchoscopy, 1 allergy skin testing). In 89 cases the cause of chronic cough was determined by procedures available to the referring physician. In most cases chronic cough in children can be diagnosed and managed by physicians who are aware of the spectrum of common disorders that lead to cough.