CHRONIC COUGH IN PEDIATRICS

The objective has been to identify the different etiologies and elabor ate a diagnostic and therapeutical methodology for patients with chron ic cough. During one year we studied prospectively 83 patients with pe rsistent cough of daily appearance with an evolution of four or more w eeks and no previous etiologic diagnosis. We worked on three diagnosti c (D) levels. D1: Based on the anamnesis and physical examination. D2: Sequential incorporation of complementary exams. D3: Evaluation of th e response to the specific treatment. We divided the population into 2 groups: G1 healthy children, G2 children followed in our hospital for different conditions. The mean age was 4.7 years (range, 3 months to 15 years), and the average duration of cough was 4.9 months (range, 1 to 36 months). In G1 the following causes were identified in 78 childr en: cough variant asthma 41 (52%), asthma + upper respiratory tract in fections 8 (10%), asthma + lower respiratory tract infections 6 (7%), postnasal drip syndrome (sinusitis, adenoiditis) 5 (6%), psychogenic 6 (7%), undetermined 4 (5%), gastroesophageal reflux 2, asthma + cigare tte 2, AIDS 1, Sjogren syndrome 1, vascular ring 1, cricopharyngeal fo reign body 1. In G2 out of 5 children we have found: 2 children with c hronic encephalopathies who had swallowing disorders and gastroesophag eal reflux, 1 patient with Down syndrome presenting hypogammaglobuline mia and bronchiectasis, 1 tracheaesophageal fistula in H in a child wi th recurrent pneumonia, 1 lymphocytic pneumonia in an AIDS patient. Th e D1 was correct in 92% of the cases. The specific therapy has proved useful for achieving the remission of the symptoms. Although asthma is the most frequent cause of chronic cough, other etiologies exist and must be ruled out.