How Cronic Cough In Kids Can Help You Improve Your Health

The outline of the talk today will be to go through a quick review of the definition of chronic cough, we will discuss options for the treatment of chronic cough, including home remedies, medications, and prevention, and then finally will review when and why to visit a pediatric pulmonologist.

Why do we cough?

We cough for many reasons.
We cough to protect our airways from irritants.
We cough to clear the mucous made daily.
The extra mucus we have when we're sick.
Coughs can be an early warning sign of disease.

How do we cough?

We have many cough receptors in our bodies
In this picture here,
The dots show where they all are strategically located throughout the airway,
Their job is to sense irritants and send signals up to the brain,
That sends signals back to the body to produce that cough.

How do we know when a cough is chronic?

A cough lasts for less than a month, and these are usually caused by viral illnesses.

The symptoms last 7 to 14 days, and in 90% of the cases, the symptoms and the cough go away on their own. But the cough is called chronic if this cough lasts for more than a month. Some viral illnesses cause a cough that lasts for more than 4 weeks, but the pediatric community uses this cut-off to make sure They're not missing any more serious underlying conditions.

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 because there are many causes.

Some Common Causes-:

Foreign Body In The Airway

The more common cause that we are looking for, is asthma.
Foreign body in the airway or even in the ears that can trigger those cough receptors.
Gastrointestinal issues can actually cause a chronic cough.
This would be gastroesophageal reflux or GERD.
Where food is coming up towards the airway and irritating and causing coughs.
People or children can have trouble swallowing.
Food can go towards their airway.

Tic Cough & Habit Coughs

A habit cough is a cough that often starts as a viral illness.
But over time the cough receptors become more sensitive.
It turns into this vicious cycle of this harsh.
Honking loud cough, and actually.
The habit of cough can go away, sometimes fairly quickly.
With specialized therapy and cough biofeedback.
Then also some infections can cause a chronic cough.
A variety of them bacterial, sometimes viral.

Upper Airway Cough

Then there is something called upper airway cough syndrome.
Formerly known as postnasal drip.
This is actually caused by underlying issues such as allergies, sinusitis, and irritants such as smoke.
Sometimes the tissue in the upper airway called the adenoids can be large and cause congestion.
Lead to cough--post nasal drip and cough.

Many other common causes 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 such as that.

That's why it's important to involve a pediatric pulmonologist because there are so many causes that were trained to identify and treat and manage them.

Treatment for the chronic cough

Treatment for the chronic cough. Before I get into the details, just a couple of words about the expectations when we're treating 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.
Reassurance.

Chronic cough can be very frustrating. It leads to poor sleep, and children sometimes miss school, work for parents, and sometimes even the cough becomes chronic, and at some point, it's not contagious anymore, but children may get sent home from school.

It's also frustrating for health care providers because They 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 is usually found.

This may take thorough evaluation and frequent follow-up with the pediatric pulmonologist, but then the cause is usually discovered, and many times the cough will go away, depending on the underlying cause of what's causing the cough, and the good news is that we're here, pediatric pulmonologists, for you, and experts exist in this field who is trained to help treat chronic cough?

A lot of people are interested in, our home remedies and things we can do at home that don't involve prescription or medication, and the one caveat for this are the home remedies.

Home remedies-:

They aren't specifically for chronic coughs.
They're often for colds or viral illnesses.
The acute cough.
I'm mentioning them because as long as they don't cause harm.
They can be used often as:
An adjunct.
Treatment for the chronic cough and the cough that doesn't improve.
Please seek medical attention right away.

Nasal saline rinse

This acts as a decongestant
Can help with a cough
That's caused by postnasal drip
In younger kids
Need the saline drops and some bulb suctioning,
Older kids will be able to blow their noses.

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.

Honey

Honey has actually been studied.
It can decrease the coughing of children at night.
Help children get better sleep.
As well as the parents can sleep better too.
The actual mechanism of this isn't known why it works.
There are a lot of theories.
It is thought that it can coat or smooth the throat.
It is also thought to have antibacterial properties.
Antioxidant or anti-inflammation properties.
It is also thought that it can make more saliva.
This can trigger nerve receptors in the tongue.
That can decrease the activation of cough.
Nobody really knows. But it has been shown to have some effect.
The other big secret about honey is that it is not recommended.
Do not give it to children who are under a year old.

This is because they're—:

These younger children are at risk for a toxin
That can be found in honey
That can cause infant botulism,
This is a life-threatening condition.

Children under 1year do not get honey, but if they're old enough, then you can give toddlers and younger kids half a teaspoon at night, and older kids can get 1-2 teaspoons.

As very commonly you'll hear this, is to drink liquids and stay hydrated.

Drink liquids and stay hydrated.

This is because-:

When you're hydrated.
Also the mucus layer in your body.
In your airway is hydrated.
The mucus is thinner and less sticky.
Can move out of your airways 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 yes, thought to loosen secretions and also may stimulate some receptors near the tongue that can decrease cough activation.

And then also some records, some therapies that are commonly recommended but have not been studied as much as the others that I mentioned are the cool mist humidifier, The only issue or the 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.

The other one is cough drops

This is for older children.

The thought--or lozenge there also called.
These are thought to be able to soothe.
Coat the airway.
Also for people with the habit cough.
It can help distract them from coughing.
The risk with this one
It can be a choking hazard.
Just be careful.
The throat lozenges are upright.

The other thing people wonder about is the vapor rub.

Vapor Rub

Aromatic vapor rub on the chest.
That's not indicated for chronic cough.
People do try to use that for acute short-term cough.
Nasal congestion has been shown to relieve the sensation of nose congestion in people.
But because there are risks of rash.
It's not recommended in chronic cough.
The-counter medications.

Unfortunately

These are for coughs and cold therapy.
For Cough suppressant medications.
These are not recommended in children under 6 years old.
They're not encouraged in children under 12 years old, either.
This is not encouraged for acute or chronic cough,
Because research has shown that they are not much more effective than doing nothing or a placebo.

There are many reports of toxic side effects.

Nausea.
Dizziness.
Seizures.
Problems breathing.
There have been cases of overdose and death.

Because of all those things, again the experts weigh the risks and benefits of all the therapy they use, and the risks of using these medications with side effects.

There are still these considerations of side effects, so if your child is using the medicine and they have any side effects, or it's not working, please stop the medication immediately.

A quick note on the medications that suppress coughs, this would be such as dextromethorphan, that's found in Robitussin or Delson or some brand names, they often don't recommend those either because of the side effect.

But also, again, they really encourage cough because that's what's helping to clear the mucus, and if the mucus is stuck down in the throat, it can actually in the airway, it can actually lead to more problems and infection, so we do want people to clear the mucus.

Some medications are very targeted toward certain causes of chronic cough

The first one is asthma, and asthma is a condition that is often underdiagnosed and undertreated.

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.

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, instead of as-needed medication.

The inhaled corticosteroid.

Which is the inhaler.

Slow-acting medication to help calm down the inflammation in the airways.
Prevent it from becoming worse with triggers or illness.

Other medications, there are medication by the mouth that is asthma controller medications as well, or oral steroids if the cough is very bad and affects your child greatly.

They will be put on a 5-day course of oral steroids to help calm down the symptoms, and the important thing to remember, 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 space is very important because you're using medications, but we have to make sure they're being used properly.

Another condition is allergies that there's a specific treatment for, and these medications are called antihistamines. Some brand names are Zyrtec, Claritin, and Allegra, and they help block this molecule called histamine, which causes all the allergic responses in the body. And some nasal corticosteroid sprays can be used every day.

They're slow-acting.

They also help to calm down the inflammation,
Such as Flonase
Or Nasonex,
Those might be trialed as well.
Gastroesophageal reflux or GERD.
As I mentioned before when the food comes up.
The acid can trigger coughs and wheeze.
There is a medication like Zantac or Prilosec that can help suppress or block stomach acid.

This is also medication that helps the gut move, so the food stays down and doesn't come up towards the airway, but in 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 and evaluation.

A specific conditions that might be causing the cough, and how the treatment would be:

Bacterial infections

The treatment for this is antibiotics.
There are many different types of infections out there.
Sometimes it will be months.
The key is to have close guidance with your physicians and to come up with the proper diagnosis.
The experts really want to avoid overprescribing antibiotics.
Before you're started on the antibiotics there might be another testing that's done first.

The key is if you are prescribed the antibiotic, make sure that you complete the whole course. And then next up on the 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.

This is the first one I have on the list, to avoid the triggers that worsen the cough.

Just tobacco smoke or allergens.
If you have allergies or asthma.
Also important is not catching a cough or sharing germs with others.
Always remember 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 like this.
Cough in here, and also remember good hand-washing.

There are options available.

In terms of vaccines for some conditions.
That is known to cause a chronic cough.
Such as pertussis.
Which causes whooping cough.
The flu vaccine can prevent influenza.
Which's more known to cause long-term lung damage.
If we can prevent that, that is wonderful.

When and why to visit the pediatric pulmonologist?

The when:

If your child's cough is lasting more than a month.
Please go see a pediatric pulmonologist.
If it's been less than a month, but the cough is worsening.
If there are any red flag symptoms or other symptoms that are going along with the cough that seems more than a viral illness.
That would be if your child has any weight loss, other infections, also poor growth, or any other concerns that you may have.

Why visit pediatric pulmonology?

Pediatric pulmonologists have years of extra training in pediatric lung disease, and when you go to the clinic and you can meet specialized lung function testing that's performed by respiratory therapists or experts and they're very familiar with performing these tests with children.

There are comprehensive symptom evaluation surveys and intake forms that need to be treated really important is that hospitals have a multidisciplinary with a big team approach.

Some Reasons Like They Have-:

Respiratory therapists.

Certified pulmonary nurse specialists.
Dieticians.
Social workers.
Everyone's trained to teach and provide you with the best knowledge that they can about pediatric lung disease.
You can always go online and look up, pediatric pulmonology, and in summary, chronic cough.
Chronic cough is treatable, and there are many successful treatment options.
The treatment depends on what they think is causing the cough, and when the cough is chronic, encourage evaluation by a pediatric pulmonologist because they can provide testing, monitoring, and close follow-up.

The treatment that we choose is usually based on what they think is causing the cough.

Not exactly what the cough sounds like.

But the sound of the cough can give some clues.

The wet cough will make them think more of the gastroesophageal reflux of food coming up or postnasal drip or one of the possibly congenital lung diseases that makes it more difficult to clear mucus, whereas the dry cough, may make them think more of asthma or a foreign body.

But it's not always 100%, the sound of the cough.

What if I don't bring my child to the doctor for a chronic cough?

We all do hope that coughs go away, but a lot of times the chronic cough is more than just a viral illness, so we want to treat and identify the underlying cause of the cough as soon as we can, and this is so we can prevent any long-term lung damage or like I mentioned if there's something a lung tumor, we want to identify that as soon as possible and treat it right away.

Can the color of the phlegm tell us anything about the cause of the cough?

Like the sound, the color of the phlegm doesn't tell exactly what's causing the cough, but there can be hints of clues of conditions going on, like yellow or green phlegm can mean an infection, viral or bacterial, so anyone can tell the difference between those.

Clear phlegm can be more like a viral illness potentially, allergies, and brown or red phlegm can mean something like blood.

What about air filters for chronic coughs?

On the air filters, they have been studied, and there is mixed evidence on that, and that's mixed evidence whether it works or not, but it's that people have allergies to animal dander, dogs, and cats. It seems like the air filters can help.

The experts won't say don't try them, they always would say try them. They can be expensive but welcome to try them, and if they help, that's wonderful, but they can't guarantee that they would help the cough.

Conclusion-:

If somebody s got a chronic cough that you are trying to work out on a test the first thing you want to do is make sure you've got a chest x-ray to rule out the infectious problem and then look at their med list to make sure they are not an ACE inhibitor.

And it's going to cause you to clear your throat and that s what we call postnasal drip or allergic rhinitis postnasal drip allergic rhinitis, what are the symptoms of that clearing your throat a lot, if you look in the back of the throat you see this thing called cobblestone in you have got itchy eyes or allergies itchy eyes.

Think about all those things in terms of postnasal drip or allergic rhinitis and I would say out of all the people who have a chronic cough or what we have eliminated this accounts for about 9% of that so think about that the next time someone is suffering with a chronic cough its quite possible that it could be dealing with someone with post nasal drip.

The treatment for that is to try to identify the things that are calling the app that's causing the allergies but the treatment generally speaking is intranasal steroids, you have heard of things like Nasonex you have heard of Flonase you have heard of a stolen or asked for pro as these are all kind of intranasal steroids or antihistamines.

Another thing that's indicated for allergic rhinitis is Singulair so that might be something else that you could use for a possible chronic cough and if those symptoms fit that's great, let us go on to the next possibility The next possibility is also around 9% and then instead of coming from the top down it comes from the bottom up.

You have got your airway but right next to your airway in fact right behind your airway is your esophagus which goes down to your stomach and if you have got stuff in there and you get something called gastroesophageal reflux disease, can sometimes come in and irritate that airway and cause what we call GERD.

GERD-related cough can happen actually in young people you don't have to be old typically what you see is an acid taste in the morning let's lighten that up here so you can see it a bit better so acid taste in the morning you obviously have the symptoms of gastroesophageal reflux disease.

That's heartburn sometimes you might have erosions from the acid in the back of your throat or specifically in your teeth you might have erythema there, if someone were to look down into your throat like it ear nose and throat physician they had to see that IV erythematosus.

You can use a proton pump inhibitor you can actually get that over-the-the-counter called Prilosec or you can get Protonix Pinto Brasil there are so many different types of proton pump inhibitors but there are some other things that you can do.

You can take the head of your bed and put it on two bricks so that it's facing up alternatively you could also get a wedge the purpose of this is to keep the head of your bed up so that the abdominal contents don't come up and bathe the trachea they stay down.

But other things that you can do is not eat three hours before lying down and then there is this sphincter which is right here at the stomach and there are a few things that we know about that can cause that sphincter to open up.

You want to avoid those things, those things that we would avoid especially at night would be alcohol caffeine spicy foods and chocolate.

If that seems befitting and they're good then these are the kind of things that you might want to make sure that you're not doing the last one is probably the most common this is about 39% so this is probably the majority and that's asthma, they don't wheeze they just COFF or maybe they do wheeze but they don't have to but just coughing could be a symptom of asthma.

That alone might do it and, what are these types of patients they're going to have the symptoms of asthma except instead of wheezing they go to coughs, oh there's going to trigger maybe they've got down feather pillows or down feather comforters so look for triggers like down or pets in the bedroom or allergies, you're not going to really know that this is what's going on unless you do a pulmonary function.

How you treat asthma here is the trick though most of the time this chronic cough is not due to just one of This is actually due to multiple and you'll see that there overlap between these different areas.

You might have to employ different treatments in all of these different places so think about that the next time you have someone with chronic cough think about cough variant asthma which is this one think about gastroesophageal reflux disease which is this one and think about allergic rhinitis.

Shocking Facts About Cronic Cough In Kids.

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