Evaluation and Workup
Bhatia also discussed what to cover while taking a history and questions to ask. The history should include the type of cough, the onset timing (sudden vs gradual), associated symptoms, the cough trajectory, medications the patient is taking, and the patient’s past medical history and environmental exposures. Those attributes are included in this more comprehensive list of questions to consider during evaluation, adapted from a list provided in a 2019 article in Paediatric Respiratory Reviews:
- Age of onset and duration?
- Was the onset sudden or associate with an illness?
- Is the cough wet or dry?
- What does the cough sound like?
- How often does the cough occur?
- Is it progressive?
- Is it present during sleep?
- Are there any other associated symptoms, such as wheeze, dyspnea, vomiting, chest pain, etc?
- Are there any exacerbating factors or known triggers?
- Are there any relieving factors, including a trial of bronchodilators?
- Has there been exposure to auto-irritants, such as secondhand smoke?
- What is the cough’s effect on the child and on others around the child?
- Does the child have any other underlying conditions such as neuromuscular disease or asthma?
- What medications is the child taking or has recently taken?
- Is there a family history of atopy and/or respiratory disease?
Bhatia also recommended paying special attention to the following red flags or key features that may help more quickly narrow the diagnosis and often require a specialist referral:
- Digital clubbing, failure to thrive, or low tone
- An abnormal cardiac exam
- Tachypnea, hypoxemia, chest retractions, or hemoptysis
- Abnormal breath sounds such as unilateral wheezing or coarse crackles
- Abnormal spirometry in those aged 5 and older showing reversible obstruction, which often indicates asthma
- An abnormal chest x-ray with, for example, bilateral infiltrates, hyperinflation, right middle lobe syndrome, situs inversus, unilateral hyperlucency, a right aortic arch, etc.
No external funding was used for the presentation. Bhatia and Quijada had no disclosures.
A version of this article appeared on Medscape.com.