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Prolonged (Chronic) Cough In Children


  • Prolonged (chronic) cough is a common problem in children.
  • Cough arises from any causes involving upper airways (nose, throat) and/or lower airways (windpipe and lungs).
  • Even though viral infections of the airways and lungs are the most common cause, the other rarer causes of prolonged cough need to be excluded.
  • Chronic productive cough with purulent phlegm production always needs further evaluation to exclude potentially serious illnesses or treatable causes.
  • Chronic cough in children are different with chronic cough in adults in many different ways.


Source: http://en.wikipedia.org/wiki/cough

Definition of chronic cough 

  • Generally, chronic cough in children is defined as cough lasting longer than eight weeks.
  • The eight week definition identifies those who need further investigations.
  • This time frame is used because most viral infective causes of cough will resolve in 1- 3 weeks.
  • Before investigating further.
  • However, if the cough is not improving by the third week or is increasing in severity, earlier investigations are needed. 

Classification of chronic cough 

  • There are many ways to classify chronic cough.
  • It can be defined based on causes (specific and non-specific), duration, age of the child or cough characteristic (wet or dry, brassy etc).
  • Generally, it is simpler to classify chronic cough in children into specific and non-specific cough, with an overlap.   
    • ‘Non-specific’ cough – refers to chronic dry cough without any abnormal pointers (table 1) in history and physical examination.
      • Majority is likely due to post-infectious or post-viral cough and/or cough receptor hypersensitivity.
      • Others include recurrent viral infections, pertussis-like illnesses, and psychogenic cough.
    • ‘Specific’ cough – refers to cough in the presence of pointers/red flags (table 1) which suggest underlying causes.


 Common causes of childhood specific chronic cough 

  • The common causes  of chronic specific cough in children  includes:
    • Bronchial asthma (link to asthma)
    • Protracted Bacterial Bronchitis (PBB)
    • Upper Airway Cough Syndrome (postnasal drips)
    • Gastroesophageal Reflux Disease (GERD)
    • Tuberculosis (link to berculosis)
  • Other less frequent causes are as follows
    • Suppurative lung diseases (eg. Bronchiectasis)
    • Bronchiolitis obliterans
    • Whooping cough (pertussis)
    • Recurrent aspiration pneumonia
    • Immunodeficiencies
    • Airway anatomical abnormalities eg.tracheobronchomalacia
    • Cystic fibrosis
    • Cardiac abnormalities 

Assessment and management of chronic cough 

  • Any child with chronic cough should be seen by a doctor for a thorough evaluation.
  • Appropriate relevant investigations will be performed as indicated.
  • The extent of investigations should be based on clinical setting, population examined, and available expertise. 

What are the investigations for chronic cough?

  • Normally your doctor will order a chest radiograph and lung function test (spirometry) in older children.
  • Further investigations will depend on clues of specific pathology.
    • Your doctor may check your child’s phlegm for microscopic examination and culture to many pathogens.
    • If your child has contact with Tuberculosis (TB) patients, TB work-up will be carried out.
    • Allergy skin testing or blood test for specific allergic testing (RAST) if atopy/asthma are likely diagnoses.
    • Your doctor may take your blood for immune work-up or HIV testing if your child has recurrent chest infections or failing to thrive.
    • Special tests like Chest HRCT (High-Resolution Computed Tomography), 24-hour pH study, Barium swallow, Bronchoscopy etc may be done if indicated.

How do we treat children with chronic cough? 

  • The specific treatment will depend on the identifiable causes. Discuss with your doctor accordingly.
  • Exposure to cigarette smoke should be removed whenever possible.


  • For post-viral cough or cough reflex hypersensitivity, it is advisable to adopt wait and see approach. Parents are assured that majority will resolve spontaneously. The children should be follow-up for emergence of specific etiologic pointers.
  • Cough suppressants and other cold medications are not advisable especially in young children because of potential serious side-effects.
  • If cough-variant asthma is a possibility, a trial of anti-asthma therapy may be used (e.g. inhaled corticosteroids). If cough does not resolve during medication trial within expected response time (eg. minimum 4 weeks), the medications will be discontinued. Your doctor then will consider other diagnoses. 


  1. Chang AB et al. Guidelines for Evaluating Chronic Cough in Pediatrics: ACCP Evidenced-based Clinical Practice Guidelines. Chest 2006;129:260S-283S.
  2. Chang AB. Cough: Are children really different to adults. Cough 2005, 1:7
  3. De Jongste JC et al. Chronic cough in children. Thorax 2003,58:998-1003.


Last Reviewed : 28 June 2016
Writer : Dr. Ahmad Rustam b. Zainuddin
Accreditor : Dr. Norzila bt. Mohamed Zainudin