Cough

Believe it or not, cough is a "good" thing. A cough helps to defend and protect our airways from things trying to enter our lungs. Unfortunately a cough can be nagging, persistent, painful and can be disruptive to our daily lives (just ask anyone who’s had a child sent home from school for coughing). A chronic cough is an incredibly challenging diagnostic problem. A cough, in and of itself, does not point to a specific illness. The word "chronic" implies that it has been going on for a prolonged period of time, but there are not clear definitions for what that time period is. Your pediatrician or pediatric pulmonologist will likely need to take an extensive history and perform a physical examination in order to better identify the cause for a chronic or persistent cough and to recommend a treatment.

What causes a cough?

There are many reasons for a cough to occur. We cough if food or liquid, upon swallowing, enters the voice box or vocal cords. This is called the laryngochemoreflex and is a way for the body to protect the lungs from aspirating food or drink. Cough can also occur if there is ongoing inflammation in the lungs. Inflammation can be caused by infections such as a respiratory virus, allergens such as pollen, noxious exposures such as tobacco, and can be exacerbated by underlying conditions such as asthma.

What are the different types of cough?

Coughs can sound different depending upon the location of the cough's initiation and the anatomy involved. For example, croup is a narrowing up the upper airway often related to a viral infection and subsequent edema. This cough can be very barky or even brassy and has been likened to that of a barking seal. Coughs can be dry or wet, seasonal or all year round. They can come in spasms, as single episodes and can occur with exercise or with eating and drinking. Unfortunately, no cough is specific enough to make a diagnosis and you should always consult with your pediatrician or pediatric pulmonologist (lung doctor) if your child has a concerning cough.

What are the characteristics of a cough?

A cough can be associated with other activities such as running, sleeping, eating or drinking. It's important to pay careful attention to when your child coughs as a cough as the time of day, associated activity, position of the child or age at which the cough started can really help the pediatrician or pulmonologist better understand the cough. Below are some associations with various causes of coughing. This list is not comprehensive and there are many overlapping conditions and associations. Please consult your physician for support in making a diagnosis or the initiation of any treatments.

Associations:

Exercise

• Exercise induced asthma

Eating or Drinking

• Aspiration

Walking the Streets of NYC

• Air pollution

Failure to thrive or poor weight gain

• Cystic fibrosis

• Chronic infections

• Chronic aspiration

Anxiety

• Somatic cough (formerly psychogenic or tic cough)

Time of Day:

Early Morning

• Allergies

• Sinus infection

Daytime

• Exercise induced asthma

Night time

• Asthma (in the middle of the night)

• Allergic rhinitis (all throughout the night)

• Reflux

All day and night

• Asthma

• Infections

Age of Onset:

Other Descriptions:

“Barky” cough

• Croup

• Tracheomalacia

Wet cough

• Infection or Inflammation

  • Allergies

  • Asthma

  • Cystic fibrosis

  • Bronchitis

  • Viral or bacterial infections

Dry cough

• Asthma

• Second hand tobacco smoke exposure (passive smoking)

“Honking” cough

• Somatic cough