Chronic cough in preschool aged children

A 20 month old boy is brought for review in general practice because his parents are concerned that he has had a persistent cough for nearly six months. Six weeks ago, he was diagnosed with a lower respiratory tract infection based on crepitations heard on auscultation. He was given a five day course of amoxicillin and his cough improved slightly, but only for a few days. A subsequent trial of inhaled salbutamol was ineffective. A week ago, he presented to the emergency department by ambulance as his parents were concerned about noisy breathing and cough. He was given dexamethasone for a clinical diagnosis of croup and discharged later that day.

His parents expect him to have frequent viral infections as he attends nursery, but report that the cough continues even when he is well. He is fully vaccinated, appears to be thriving, and is very active. His development is normal. On examination, he is coughing and appears coryzal. He is afebrile and chest examination is normal, apart from rattly transmitted upper airway sounds. He has had no investigations for his cough to date.

Cough is a common reason for preschool children to be seen in primary or ambulatory care. Estimated prevalence ranges from 5% to 23% of all primary care encounters.1 Although causes of cough are usually self-limiting, healthcare professionals need to consider and exclude potentially serious underlying …