Recurrent Cough Research Articles

Trajectories of cough without a cold in early childhood and associations with atopic diseases.

Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood. The objective of the study was to describe the latent class trajectories of cough from one to 10 years old and analyse their association with wheezing, atopy and allergic diseases. Questions about cough, wheeze and allergic diseases were asked at 1, 1.5, 2, 3, 4, 5, 6 and 10 years of age in the European prospective cohort of Protection against Allergy: STUdy in Rural Environment (PASTURE). Specific IgE assays were performed at 10 years of age. Questions regarding a cough without a cold were used to build a latent class model of cough over time. Among the 961 children included in the study, apart from the never/infrequent trajectory (59.9%), eight trajectories of cough without a cold were identified: five grouped acute transient classes (24.1%), moderate transient (6.8%), late persistent (4.8%) and early persistent (4.4%). Compared with the never/infrequent trajectory, the other trajectories were significantly associated with wheezing, asthma and allergic rhinitis. For asthma, the strongest association was with the early persistent trajectory (ORa =31.00 [14.03-68.51]), which was inversely associated with farm environment (ORa =0.39 [0.19-0.77]) and had a high prevalence of cough triggers and unremitting wheeze. Late and early persistent trajectories were also associated with food allergy. Atopic sensitization was only associated with the late persistent trajectory. Late and early persistent coughs without a cold are positively associated with atopic respiratory diseases and food allergy. Children having recurrent cough without a cold with night cough and triggers would benefit from an asthma and allergy assessment. Growing up on a farm is associated with reduced early persistent cough.

Anesthesia management for tracheoesophageal fistula closed with a new gastrointestinal occluder device: a case report

BackgroundTracheoesophageal fistula (TEF) is a rare but life-threatening complication after esophagectomy. A new gastrointestinal occluder device provides treatment for TEF patients. However, TEF-related pneumonia and respiratory failure increase the difficulty of anesthesia management, especially in airway management.Case presentationA 64-year-old man with thoracic esophageal cancer underwent esophagectomy and gastric tube reconstruction one year ago. The patient presented with recurrent cough and sputum after surgery. Gastroscopy revealed a fistula between the esophagogastric anastomotic site and membrane of the trachea. Therefore, the patient received implantation of a new gastrointestinal occluder device under gastroscopy combined with tracheoscopy. Airway management under general anesthesia was discussed with an interdisciplinary decision, and cuffed endotracheal tube with an inner diameter of 5.5 mm was chosen. This airway management ensured adequate oxygenation during the operation and provided sufficient space for the operation of the tracheoscope in the trachea. Finally, the TEF disappeared after the operation, and the patient was administered an oral diet on the first postoperative day.ConclusionsThe implantation of a new gastrointestinal occluder device under gastroscopy combined with tracheoscopy provides a new treatment for TEF patients. This case report suggests that it is important to select an endotracheal tube with an appropriate inner diameter that can not only meet the requirements of ventilation but also does not affect the operation of tracheoscopy in the trachea.

Sinusitis, otitis media and diffuse bronchiectasis in both lungs

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive or X-linked biallelic mutations inherited disease, characterized by motile cilia dysfunction. Typical manifestations include bronchiectasis, secretory otitis media, sinusitis, situs inversus, and infertility. PCD often needs to be differentiated from cystic fibrosis (CF) because of similar clinical manifestations. In this paper, a juvenile female who presented with recurrent cough and expectoration with fever since early childhood, had a history of secretory otitis media and sinusitis, and had been considered for the diagnosis of CF. After the discovery of compound heterozygous mutations in PCD related pathogenic genes by gene sequencing, combined with the clinical manifestations and imaging characteristics, PCD was finally diagnosed.

A Case of Spontaneous Pneumomediastinum Following Exacerbation of Bronchial Asthma in Adolescents

Lack of knowledge in the management of spontaneous pneumomediastinum condition is attributable to its scarcity. Hypothetically, this condition arose during the exacerbation of bronchial asthma, leading to a recurrent forceful cough that increased the intraalveolar pressure and alveoli perforation. We present a 14-year-old boy with three days history of progressively worsening shortness of breath and chest pain radiating to the neck following exacerbation of bronchial asthma. Clinically, he was stable, despite remarkable subcutaneous emphysema over the anterior chest wall and the neck. Lung examination was unremarkable. There was substantial radiological evidence of subcutaneous emphysema, pneumomediastinum, pneumopericardium and pneumorrhachis. He was managed expectantly with oxygenation, control of bronchial asthma symptoms and analgesia. Subsequently, his symptoms resolved, and a complete resolution was seen as evident by radiological assessment. Spontaneous pneumomediastinum with pneumopericardium, pneumorrhachis and subcutaneous emphysema is a rare condition that requires prompt identification to prevent if from becoming a life-threatening condition.

Double Aortic Arch as a Rare Condition in a 10-year-old Boy with Recurrent Pneumonia: A Case Report Study

Introduction: A double aortic arch (DAA) is a congenital anomaly of the aortic arch, which is also the most common type of complete vascular ring. This vascular ring can compress the trachea and esophagus, as well as cause respiratory, gastrointestinal, and cardiac symptoms. Case Presentation: In the present case report, a 10-year-old boy with recurrent cough, fever, shortness of breath, chest pain, and a history of recurrent respiratory infections was examined. According to the results of bronchoscopic evaluation, he was found to have a localized tracheomalacia. DAA and dextrocardia condition were also confirmed for this patient by performing a computed tomography angiography of the thorax and the three-dimensional reconstruction of CT angiography. Conclusions: The diagnosis of double aortic arch may be confused with upper respiratory tract infections or foreign body aspiration. Therefore, it was recommended that a particular attention should be paid to the double aortic arch when evaluating cases of stridor in children with unknown causes or recurrent respiratory infections. CT angiography and cardiac MRI were the diagnostic methods of choice for examining vascular rings.

Infected Bronchogenic Cyst with Mycobacterium tuberculosis as a Cause of Respiratory Distress: A Case Report

Bronchogenic cyst is a common primary cyst of the mediastinum, and it is usually located in the middle mediastinum and intrapulmonary regions. Bronchogenic cysts are lesions of congenital origin that occur due to abnormal budding from the primitive ventral foregut. They are common in the pediatric age group and have symptoms of respiratory distress, recurrent cough, wheezing, and stridor. Definitive management involves surgical excision. We herein report our experience of a bronchogenic cyst complicated by Mycobacterium tuberculosis infection in an 8-month-old infant. The patient underwent a right posterolateral thoracotomy, and an intrapulmonary bronchogenic cyst filled with purulent fluid was excised. The patient was given antituberculous medication, and the post-operative outcome was good.

Lung adenocarcinoma with EGFR 19Del and an ALK rearrangement benefits from alectinib instead of an EGFR-TKI: A case report

Rationale:A remarkable concurrence of an EGFR mutation and an EML4-ALK fusion (double positive) occasionally occurs within a narrow number of patients. Previous studies using targeted therapy on EGFR/ALK co-mutated patients have commonly focused on single tyrosine kinase inhibitors (TKIs) or on the sequential use of EGFR-TKIs and ALK-TKIs. At present, no consensus exists regarding the treatment of patients with double positive mutations. The effectiveness of precision therapy also remains unknown.Patient concerns:A 53-year-old female non-smoker who described recurrent coughing and blood in her sputum over a month-long interval was examined at a local hospital.Diagnosis:Using computed tomography (CT) and positron emission tomography CT (PET-CT), the patient was diagnosed with Stage IVb lung adenocarcinoma (T4N3M1).Interventions:The patient had a novel ALK-RAB10 rearrangement identified using DNA sequencing, which, at the transcript level, was actually a canonical ALK fusion that caused a response to alectinib therapy.Outcomes:The patient has achieved partial remission (PR), with a progression free survival (PFS) of 16 months, and continues to benefit.Lessons:Our results may indicate differential sensitivities to TKIs in patients harboring an EGFR mutation and an ALK rearrangement. Our patient’s response to alectinib, instead of to EGFR-TKIs, may lead to an expanded list of alectinib beneficiaries who have rare gene co-alterations in lung adenocarcinoma.

Laryngeal cleft repair – formal suture technique

Laryngeal clefts are congenital anomalies characterized by an abnormal connection between the upper airway and esophagus due to incomplete fusion of the tracheaesophageal septum. These clefts can be mild, with just a deficiency of soft tissue in the interarytenoid space (Type 1) or can extend down into the cartilage of the cricoid (Type 2) as well as into the trachea (Type 3, 4). Presentation of laryngeal clefts is most often characterized by aspiration of thin liquids, recurrent respiratory infections, cough, respiratory distress, and cyanotic episodes. The treatment of Type I laryngeal clefts can be conservative, such as with thickening of feeds and medical management or procedural, such as with injection laryngoplasty or endoscopic surgical repair. Endoscopic surgical repair has been utilized to repair these clefts for several decades, and more recently is being utilized to repair deeper clefts that were previously repaired via an open approach. In this article we will describe the background and indications for repair of laryngeal clefts, and the details of the endoscopic suturing technique. Laryngeal clefts are congenital anomalies characterized by an abnormal connection between the upper airway and esophagus due to incomplete fusion of the tracheaesophageal septum. These clefts can be mild, with just a deficiency of soft tissue in the interarytenoid space (Type 1) or can extend down into the cartilage of the cricoid (Type 2) as well as into the trachea (Type 3, 4). Presentation of laryngeal clefts is most often characterized by aspiration of thin liquids, recurrent respiratory infections, cough, respiratory distress, and cyanotic episodes. The treatment of Type I laryngeal clefts can be conservative, such as with thickening of feeds and medical management or procedural, such as with injection laryngoplasty or endoscopic surgical repair. Endoscopic surgical repair has been utilized to repair these clefts for several decades, and more recently is being utilized to repair deeper clefts that were previously repaired via an open approach. In this article we will describe the background and indications for repair of laryngeal clefts, and the details of the endoscopic suturing technique.

Three-dimensional CT angiography facilitates uniportal thoracoscopic anatomic lung resection for pulmonary sequestration: a retrospective cohort study

BackgroundPulmonary sequestration (PS) is a rare lesion with independent blood supply from an anomalous systemic artery. A timely resection is considered as the best treatment for PS. Three-dimensional computed tomography angiography (3D-CTA) has been widely utilized for precise thoracic surgery. This study aimed to investigate the role of preoperative 3D-CTA and resection simulation in uniportal video-assisted thoracoscopic surgery (VATS) anatomical lung surgery for PS.MethodsThe data of 20 consecutive PS patents undergoing anatomic lung resection between April 2011 and May 2021 in a single centre were retrospectively reviewed. These patients were divided into the 3D-CTA group (10 patients) and the control group (10 patients) according to the initial surgical planning with or without 3D-CTA. The perioperative parameters regarding safety and fluency such as the incidence of conversion to open thoracotomy, operation time, blood loss, complications and chest tube duration were analyzed.ResultsThis cohort included 12 female and 8 male patients, with a mean age of 45 years old (range 24–60 years). Nine cases demonstrated recurrent febrile, cough, or hemoptysis; whereas the other 11 patients were asymptomatic on admission. Eighteen (90.0%) intralobar and 2 extralobar PS were confirmed, whereas 18 (90.0%) lesions were located in the left thorax. The feeding vessels originated from the thoracic aorta in 16 patients (80.0%), the abdominal aorta in 3 (15.0%), and the inferior phrenic artery in 1 patient (5.0%). There was no major bleeding or 30 days mortality. The initial surgical planning included 9 uniportal and 1 two-port VATS in the 3D-CTA group, as compared with 10 two-port VATS in the control group. Thirteen lobectomies, 5 segmentectomies and 2 mass excisions were performed. However, no conversion was needed in the 3D-CTA group; whereas 6 (60.0%) conversions (4 to multiple-port and 2 to thoracotomy) occurred in the control group, indicating a significant difference (P = 0.003). In addition, the operation time in the 3D-CTA group was significantly shorter than those in the control group [(108.5 ± 24.9) min vs. (154.5 ± 39.4) min, P = 0.006]. The other surgery-related outcomes were similar between the two groups.ConclusionPreoperative 3D-CTA facilitates the safe and fluent performance of uniportal VATS anatomical lung resection for PS with shortened operation time and lessened surgical conversions.

Tuberculosis with tubercular osteomyelitis of skull

Tuberculous osteomyelitis of skull is a rare form of tuberculosis with an incidence of 0.2 – 1.3% of all skeletal tuberculosis. A 9-year-old boy presented with a history of prolonged fever, recurrent cough since 2 months before admitted and painless scalp swelling for the previous 1 month. A diagnosis of tubercular etiology was established with the rapid molecular test and histopathology of the fine needle aspiration biopsy specimen. The patient was kept on antitubercular treatment for 12 months. After 2 months treatment he responded well, with a marked resolution of symptoms and physical examination findings.

Lung cancer coexisting with Papiliotrema flavescens infection diagnosed by next-generation sequencing: a case report

BackgroundPapiliotrema flavescens is a rare environmental yeast, which has been isolated from air, trees, kernels of wheat and corn, fermenting soya sauce, and cerebrospinal fluid of patient with AIDS. Additionally, it is also reported to cause subcutaneous infection in a dog. In this case, we describe primary lung adenocarcinoma coexisting with Papiliotrema flavescens infection in a female patient diagnosed by next-generation sequencing (NGS) technique, which is the first such reported case.Case presentationThe patient was a 52-year-old female with recurrent cough for 3 months. Chest CT examination revealed a ground glass nodule of 17 * 23 * 18 mm in the right upper lung, and 3 new pulmonary nodules appeared around it 2 months later. The patient underwent right upper lobe lobectomy and pathology confirmed that the primary 2-cm-lesion in the right upper lobe was invasive lung adenocarcinoma, and two of the three surrounding lung nodules were pathologically suggestive of pulmonary fungal infection (not known in specific fungal types). Hence, the patient received empirical anti-fungal treatments with fluconazole 400 mg/day for a week and follow-up CT scanning showed no tumor progression and no relapse of fungal infection. The specific pathogen was eventually identified as Papiliotrema flavescens by the next-generation sequencing of pathogen.Discussion and conclusionWe first reported that lung cancer coexisting with Papiliotrema flavescens infection in a female patient. The diagnosis of lung cancer with typical CT imaging features is relatively simple, while the diagnosis of lung cancer coexisting with rare fungal infection is challenging. NGS technique is an effective supplementary technique for clinical diagnosis of bacterial or fungal infectious diseases, enabling precise clinical decision-making and appropriate treatment. In this case, the lung cancer may result in a degree of immune suppression, at least locally, resulting in the formation of pulmonary fungal nodular lesions around the tumor.

TU7.10 Short and medium-term symptom response to fundoplication in reflux-associated chronic cough in a UK Centre

Abstract Aim To identify whether anti-reflux surgery is an effective treatment for reflux-associated cough in a single specialist unit. Method A retrospective analysis of patients referred for suspected reflux-associated cough undergoing anti-reflux surgery over a 12 month period in a single centre. Pre-operative oesophageal physiology and imaging, operative technique and follow up records were examined. Symptom resolution and relapse was assessed four years postoperatively. Results 15 patients underwent anti-reflux surgery following referral with suspected reflux-associated respiratory symptoms. 6 patients had hiatus hernia (40%). There was no correlation between symptom improvement and presence of hiatus hernia, lower oesophageal sphincter (LOS) pressure or DeMeester score (DS). 13 of 15 patients attended initial follow-up. 12 (92.3%) reported complete or partial resolution of symptoms. Acid suppression medication was discontinued in 7 (53.8%) patients at follow up. 100% of patients with marked oesophageal dysmotility (OD) and elevated DS reported their symptoms either partially or fully resolved. One patient who reported no symptom improvement had normal LOS pressures and normal DS but marked OD. At four-year follow up, 7/13 reported symptoms (53.8%). Of these 3 have been re-referred for recurrent cough (23.1%), 1 for dysphagia (7.7%) and 2 experienced symptomatic reflux (15%). The final patient (7.7%) underwent revision surgery (partial reversal of Nissen Fundoplication) and was satisfied postoperatively. Conclusion Patients referred by the respiratory service for reflux-associated cough show good symptom improvement which is largely maintained following anti-reflux surgery. Relative contraindications of dysmotility did not appear to be predictive of worse outcome in this group.

Pulmonary Sequestration Presenting as Treatment-Resistant Community Acquired Pneumonia

Pulmonary sequestration is a rare congenital malformation whereby abnormal lung tissue forms that do not communicate with the tracheobronchial tree. Pulmonary sequestration receives its blood supply via single or multiple vessels, typically arising from the systemic circulation. Symptoms can include a chronic or recurrent cough, respiratory distress, hemoptysis, or pneumonia. Management typically involves treatment of symptoms, sometimes requiring surgery. This case reviews the clinical presentation, work-up, and management of pulmonary sequestration presenting in an adult patient.

Bronchiectasis in African children: Challenges and barriers to care.

Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.

Linear Neck Pain and Prolonged Cough Caused by Takayasu Arteritis

The clinical manifestations of Takayasu arteritis (TA) greatly vary, and this ultimately leads to a delay in diagnosis. We describe a case of TA presenting with two coexisting rare symptoms of linear neck pain and prolonged cough. A 28-year-old Japanese female with a six-month history of ulcerative colitis presented with recurrent left neck pain, cough, and fever. The neck pain and fever started five months ago. Her symptoms briefly improved with nonsteroidal anti-inflammatory drug therapy, but eventually recurred one month prior to her latest presentation to the hospital, which was accompanied by a dry cough. Physical examination revealed a blood pressure discrepancy, with systolic blood pressure being >10 mmHg lower in her left arm than in her right arm, a bilateral carotid bruit, a weak left radial pulse and radio-radial delay without coolness in the upper extremities, and linear pulsatile tenderness in her left neck along the common carotid artery. No supraclavicular or infraclavicular bruit was noted. The erythrocyte sedimentation rate was elevated at 66 mm/hour. After obtaining the images from a contrast-enhanced computed tomography, she was diagnosed with TA. All her symptoms improved with prednisone therapy. Notably, neck pain and cough are both late-stage symptoms of TA, which are seen in 9.7% and 1.5% of patients, respectively. Although her unspecific symptoms could have been easily misdiagnosed, the recurring exacerbation of symptoms warranted careful attention to a focused physical examination.In conclusion, neck pain and cough are both uncommon presentations of TA, which may lead to physicians underdiagnosing it. It is important to recognize neck pain and cough as presenting complaints in patients with TA.

Long-term respiratory outcomes following solid organ transplantation in children: A retrospective cohort study.

Solid-organ transplantation (SOT) has become commonly used in children and is associated with excellent survival rates into adulthood. Data regarding long-term respiratory outcomes following pediatric transplantation are lacking. We aimed to describe the prevalence and nature of respiratory pathology following pediatric heart, kidney, and liver transplant, and identify potential risk factors for respiratory complications. Retrospective review involving all children under active follow-up at the provincial transplant service in British Columbia, Canada, following SOT. Of 118 children, 33% experienced respiratory complications, increasing to 54% in heart transplant recipients. Chronic or recurrent cough with persistent chest x-ray changes was the most common clinical picture, and most infections were with nonopportunistic organisms typically found in otherwise healthy children. A history of respiratory illness before transplant was significantly associated with risk of posttransplant respiratory complications. Eight percentage8% were diagnosed with bronchiectasis, which was more common in recipients of heart and kidney transplant. Bronchiectasis was associated with recurrent hospital admissions with lower respiratory tract infections, treatment of acute rejection episodes, and treatment with sirolimus. Respiratory morbidity is common after pediatric SOT, and bronchiectasis rates were disproportionately high in this patient group. We hypothesize that this relates to recurrent infections resulting from iatrogenic immunosuppression. Direct pulmonary toxicity from immunosuppression drugs may also be contributory. A high index of suspicion for respiratory complications is needed following childhood SOT, particularly in those with a history of respiratory disease before transplant, experiencing recurrent or severe respiratory tract infections, or exposed to intensified immunosuppression.

Non-intubated video-assisted thoracoscopic surgery under combination of erector spinae plane block and thoracic paravertebral block

BackgroundThe use of anesthetics and analgesic drugs and techniques in combination yields a multimodal effect with increased efficiency. In this case series, we aimed to evaluate the anesthetic effect of the thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) combination in patients, who underwent non-intubated video-assisted thoracoscopic surgery (NIVATS).MethodsMedical records of 16 patients, who underwent NIVATS for wedge resection under the combination of ESPB and TPVB were reviewed retrospectively. Demographic data of patients, duration of the sensory block, amount of the anesthetic agent used for premedication and sedo-analgesia, any presence of perioperative cough, operative times, postoperative visual analog scale (VAS) scores in the postoperative follow-up period, the need for additional analgesia, and patient satisfaction were reviewed. ResultsOf the patients included in the study, 12 were men and 4 were women. The mean age was 48.6 years and the mean BMI was 24.7 kg/m2. The mean time needed for the achievement of the sensorial block was 14 min and the mean skin-to-skin operative time was 21.4 min. During the procedure, patients received 81.5 ± 27.7 mg of propofol and 30 ± 13.6 micrograms of remifentanil infusions, respectively. The mean dose of ketamine administered in total was 58.1 ± 12.2 mg. Only 2 patients needed an extra dose of remifentanil because of recurrent cough. No patients developed postoperative nausea vomiting. During the first 24 h, the VAS static scores of the patients were 3 and below, while VAS dynamic scores were 4 and below. Morphine consumption in the first postoperative 24 h was 13.2 mg.ConclusionsIn conclusion, combined ESPB and TPVB with added intravenous sedo-analgesia in the presence of good cooperation between the surgical team and the anesthesiologist in the perioperative period can provide optimal surgical conditions including the prevention of cough in NIVATS. It is not sufficient to state that this combination is superior to alone ESPB or alone TPVB, as it is a preliminary study with a limited number of cases.

Bacterial Colonization of Home Nebulizers Used by Children With Recurrent Wheeze

To look for bacterial colonization of parts of home nebulizers used for children with recurrent wheeze and asthma. Children aged 1 mo-12 y, using home nebulizers for recurrent cough and wheeze were enrolled from May to October, 2019. Caregivers were administered a structured questionnaire by a single researcher, during their hospital visit, to elicit information on their nebulizer cleaning practices. Samples were taken from nebulizer medicine chamber and tubing for bacterial culture and sensitivity. Bacterial growth was observed in 17 culture samples obtained from medicine chamber and/or tubing of nebulizers used by 12 (20.3%) out of the 59 enrolled children. The bacteria isolated were Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus (Methicillin resistant S. aureus and Coagulase negative staphylococci) and these were resistant to many of the commonly used antimicrobials. Almost 20% parents had never cleaned the nebulizers. Diluent re-use was significantly associated with bacterial colonization of nebulizer parts [AOR (95% CI) 20.6 (2.26-188.5); P=0.007]. Home nebulizers, if not cleaned properly as per set protocols, may get colonized with potentially harmful bacteria. There is a need to increase awareness about their proper use amongst parents of children with recurrent wheeze.

Langerhans cell histiocytosis in an infant: a case report

Langerhans cell histiocytosis is a rare non-malignant disease characterized by a clonal proliferation of pathological cells with the characteristics of Langerhans cells in single or multiple sites. A 7-month-old infant presented with continued fever and recurrent cough with progressive rash over the whole-body including palms and soles for over a month. On examination there was respiratory distress, generalized lymphadenopathy, hepatosplenomegaly and skin rash. The diagnostic workup for underlying causes showed ground glass opacity, pulmonary oedema and retroperitoneal lymphadenopathy on CT scans of thorax and abdomen respectively. The histopathology specimens of skin and lymph node biopsy further confirmed the suspicion of Langerhans cell histiocytosis. The patient was sent for treatment with vinblastine and prednisone to a higher centre. In this case report we highlighted the unusual presentations and prognosis of a child with Langerhans cell histiocytosis.

A multi-disciplinary approach to chronic cough in children.

Objectives(1) To highlight the important causes of chronic and recurrent cough in children. (2) To discuss multidisciplinary approach to management of chronic/recurrent pediatric cough.MethodsReview of scholarly articles, guidelines, expert panels via PubMed and Google Scholar.ConclusionChronic cough (CC) in children is mainly attributed to persistent bacterial bronchitis, asthma, nonspecific cough, and gastroesophageal reflux disease (GERD) symptoms. A multi‐disciplinary approach is cost‐effective and aids with earlier diagnosis and appropriate treatment. Congenital or acquired narrowing of the subglottis is the leading ENT cause for recurrent croup (RC) in children. Laryngeal cleft‐type 1 is commonly seen in children with recurrent aspiration and CC. Children are usually referred to pulmonologists for wet cough not responding to treatment. Eosinophilic esophagitis (EoE) and GERD should be considered in the differential diagnosis of CC in children with both respiratory symptoms and failure to thrive.Level of Evidence: 2a