We’ll be talking about treatment of chronic cough including home remedies, medication and prevention and then finally we’ll review when and why to visit a pediatric pulmonologist. So first up why do we cough, we cough for many reasons, we cough to protect our airway from irritants, we cough to clear the mucus we make on a daily basis and the extra mucus we have when we’re sick and cough can be an early warning sign of disease and how do we cough? we have many cough receptors in our body, their job is to sense irritants and send signals up to the brain and that sends signals back to the body to produce that cough and so the definition of how do we know when a cough is chronic? the definition of chronic cough is based on time and for comparison, an acute cough or a shorter term cough is one that lasts for a month, less than a month and these are usually caused by viral illnesses, the symptoms last seven to fourteen days and in a ninety percent of the cases, the symptoms in the cough goes away on their own but the cough is called chronic if this cough lasts for more than a month, there are some viral illnesses that cause a cough that lasts for more than four weeks but the pediatric community uses this cut off to make sure we’re not missing any more serious underlying conditions so when the cough becomes chronic, if it affects daily functioning or is associated with any other health problems then this is when we become concerned and start looking for causes other than viral illness and discovering the cause of a chronic cough can be challenging because there are many causes, first up i’m listing the more common causes that we’re looking for and this is asthma, foreign body in the airway or even in the ear that can trigger those cough receptors.

Gastrointestinal issues can actually cause chronic cough, this would be gastroesophageal reflux or gerd where food is coming up towards the airway and irritating and causing cough or people or children can have trouble swallowing and food can go towards their airway, also there’s a tick cough and then there could be habit coughs, a habit cough is some cough that often starts as a viral illness but over time, the cough receptors become more sensitive and it turns into this vicious cycle of this harsh honking loud cough, the habit cough can go away sometimes fairly quickly with specialized therapy and cough biofeedback and then also there are infections that can cause chronic cough, a variety of them bacterial, sometimes viral and then there’s something called the upper airway cough syndrome formerly known as post nasal drip and this is actually caused by underlying issues such as allergies sinusitis irritants such as smoke or sometimes the tissue in the upper airway called the adenoids can be large and cause congestion and lead to cough post nasal drip and cough and there are many other common causes that are less common and these often are conditions that children are born with, sometimes there are some acquired causes such as lung damage after an infection or because of some of the other conditions and unfortunately there can be tumors so we have to be aware of causes such as that and that’s why it’s important to involve a pediatric pulmonologist because there are so many causes they’re trained to identify and treat and manage them and so next up we’d review the treatment for the chronic cough. Before we get into the details, just a couple words about the expectations when we’re treating a chronic cough and i wanted to get the bad news out of the way first so there’s not always a quick fix to treat chronic cough, unfortunately the mainstay of treatment is symptom management, close monitoring and reassurance and also a chronic cough can be very frustrating, it leads to poor sleep and children sometimes miss school work and sometimes even the cough becomes chronic and at some some point it’s not contagious anymore but children may get sent home from school and you know it’s also frustrating for health care providers because we all really want to get rid of this cough very quickly and sometimes it’s just not possible but then the good news is that the cause of the cough usually will be found, this may take thorough evaluation and frequent follow-up with the pediatric pulmonologist but the cause is usually discovered and many times the cough will go away depends on the underlying cause of what’s causing the cough.

So then first up which is what i know a lot of people are interested in are home remedies and things you can do at home that don’t involve prescription or medication and the one caveat for this is that the home remedies aren’t usually specifically for chronic cough, they’re often for colds or viral illnesses, the acute cough but i’m mentioning them here because as long as they don’t cause harm they can be used often as what we say an adjunct or in addition to a treatment for the chronic cough and if the cough doesn’t improve or it’s getting worse with things you’re trying at home please seek medical attention right away and so first up is nasal saline rinse and this acts as a decongestant and can help with cough that’s caused from post nasal drip and in younger kids they’ll need the saline drops and some bulb suctioning and older kids will be able to blow their nose and these saline rinses can be done as often as you think your child needs them throughout the day, just be careful to avoid irritating the nose with the suctioning. Next is honey, so honey’s actually been studied and it’s been shown that it can decrease the coughing for children at night and also help children get better sleep and as well as the parents can sleep better too and the actual mechanism of this isn’t known of why it works, there’s a lot of theories, it’s thought that it can coat or smooth the throat, it’s also thought to have antibacterial properties, antioxidant or anti-inflammation properties as well, it’s also thought that it can make more saliva and this can trigger nerve sense, nerve receptors by the tongue that can decrease activation of cough but nobody really knows but it has been shown to have some effect and the other big but about honey is that it is not recommended, do not give it to children who are under a year old and this is because these younger children are at risk for a toxin that can be found in honey that can cause infant botulism and this is a life-threatening condition so children under one do not get honey but if they’re old enough then you can give toddlers and younger kids about half a teaspoon at night and older kids can get one to two teaspoons and next is always as very common, you’ll hear this is to drink liquids and stay hydrated and this is because you know when you’re hydrated, also the mucous layer in your body and your airway is hydrated too so the mucus is more thin and less sticky and can move out of your airway better when you cough, we actually want the mucus to move out of your airway and also involving fluids are to drink warm flavorful liquids and we have to say and this is thought to loosen secretions but your elders were right that that chicken soup or the tea with lemon can have an effect on cough and help it in theory and yeah it’s thought to loosen secretions and also may stimulate some receptors near the tongue that can decrease cough activation and then also some therapies that are commonly recommended but have not been studied as much as the others that i mentioned are the cool mist humidification and so this can put mist into the air and humidify the airway and hydrate and the only issue or risk with this is for people who have allergies because the equipment is at risk for growing mold or fungus so the thing to remember is to clean the equipment regularly and keep it in a well ventilated area and if the cough is worsening or symptoms are worsening or it’s not working then stop the therapy and the other one is cough drops, this is for older children and can be called throat lozenges, they’re also called and these are thought to be able to soothe and coat the airway and also for people with habit cough it can help distract them from coughing and again the risk with this one is that it can be a choking hazard so just be careful that when children are using the throat lozenges, they are upright and they’re not laughing or things like that so we always want to think of risks and benefits of all the treatments that we give people. Some people also wonder about the vapor rub, aromatic vapor rub on the chest that’s not indicated for chronic cough but people do try to use that for the acute short-term cough and nasal congestion that has been shown to relieve the sensation of nose congestion in people but because there are risks of rash and if people use it incorrectly it can actually worsen breathing symptoms so it’s and it’s not recommended in chronic cough.

So i’ll be talking about medications you can use, so first the over-the-counter medications, unfortunately these are for the cough and cold therapy and cough suppressant medications, these are not recommended for children under six years old and they’re not encouraged for children under 12 years old either, they’re not encouraged for acute or chronic cough and this is because research has shown that they are not much more effective than doing nothing or placebo and there are many reports of toxic side effects like nausea, dizziness, seizures, short pauses, problems breathing and there have been cases of overdose and death so because of all those things again we’re weighing the risks and benefits of all the therapy, we use risks of using these medications with side effects versus the benefits which might not be as high so they’re not recommended in young children and even for older children who can take the medicine, there’s still these considerations of side effects so if your child’s using the medicine and they have any side effects or it’s not working, please stop the medication immediately and also a quick note on the medications that suppress cough, this would be such as dextromethorphan that’s found in robitussin or delsum or some brand names, we often don’t recommend those either because of the side effects but also again we really encourage cough suppressant because that’s what’s helping to clear the mucus and if mucus is stuck down in the throat or in the airway, it can actually lead to more problems and infections so we do want people to clear the mucus and so there are there are medications that are very targeted towards certain causes of chronic cough and that’s what i’ll talk about next, the first one is asthma and asthma is a condition that’s often under diagnosed and under-treated so if with the chronic cough, if your child has any other signs that suggest asthma, wheezing triggers that are common for asthma or lung function testing that suggests it, they will be started on a trial of asthma controller medication and usually by the time they end up at the pediatric pulmonologist, the symptoms have been going on long enough and are often enough that they will need that daily control or medication and this is the inhaled corticosteroid which is the inhaler slow acting medication to help calm down the inflammation in the airways and prevent it from becoming worse with triggers or illness and other medication, there are medication by mouth that are asthma controller medications as well or the oral steroids, if the cough is very bad and affecting your child greatly there will be put on a five-day course of oral steroids to help calm down the symptoms and the important thing to remember if you have an inhaler for asthma, if you have an asthma medication inhaler to always use the chamber or spacer with it because this helps the particles be delivered properly down into the lungs instead of without it, it’s oftentimes squirted more into the mouth and swallowed so the spacer is very important because you’re using medications but we have to make sure they’re being used properly. Another condition is allergies, there are specific treatment for them and these medications are called antihistamines, some brand names are zyrtec claritin allegra and they help block this molecule called histamine which causes all the allergic response in the body and there’s also some nasal corticose steroid sprays that can be used every day, they’re slow acting and they also help to calm down the inflammation such as flonase or nasonex and those might be trialled as well, the other condition that has specific treatment is gastroesophageal reflux or gerd and this is mentioned before when the food comes up or the acid can trigger cough and wheezing and so there are medication like zantac or prilosec that can help suppress or block the stomach acid, there’s also medication that helps the gut move so the food stays down and doesn’t come up towards the airway but both of these conditions, you may have a trial of the treatment or you may be referred to a specialist for treatment and further medication choices or testing or evaluation and then lastly a specific condition that might be causing the cough and has a treatment would be bacterial infections and the treatment for this is antibiotics and there are many different types of infections out there so sometimes the recommendation will be a certain type of antibiotic for days and sometimes it will be months so the key is to have close guidance with your physicians and to come up with the proper diagnosis and we really want to avoid over-prescribing of antibiotics so before you’re started on the antibiotics there might be other testing that’s done first and the key is if you are prescribed the antibiotic make sure that you complete the whole course and then next up under treatment, i’m putting prevention because that’s always number one, if you can prevent getting a cough that’s the best or if you can prevent irritating your cough that is great too, the first one on the list is to avoid the triggers that worsen cough such as tobacco smoke or allergens, if you have allergies or asthma also important is not catching a cough or sharing germs with others so always remember the good cough hygiene, to cover your mouth not with your hand which you touch people and things with your hand after you sneeze but cover your mouth with your elbow and also remember good hand washing and also there are options available in terms of vaccines for some conditions that are known to cause chronic cough such as pertussis which causes the whooping cough and also the flu vaccine can prevent influenza and that’s more known to cause long-term lung damage so if we can prevent that, that is wonderful too and lastly when and why to visit the pediatric pulmonologists, if your child’s cough or your cough is lasting more than a month, please come see your pulmonologist, if the cough has been less than a month but the cough is worsening or if there are any red flag symptoms or other symptoms that are going along with the cough that seems more than a viral illness and that would be if your child has any weight loss, also poor growth or any other concerns that you may have, visit your pulmonologist.

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