Chapter 4.7 Conditions presenting with chronic cough

A chronic cough is one that lasts > 14 days. Many conditions may present with a chronic cough such as TB, pertussis, foreign body or asthma (see Table 10).

History

  • duration of coughing
  • nocturnal cough
  • paroxysmal cough or associated severe bouts ending with vomiting or whooping
  • weight loss or failure to thrive (check growth chart, if available),
  • night sweats
  • persistent fever
  • close contact with a known case of sputum-positive TB or pertussis
  • history of attacks of wheeze and a family history of allergy or asthma
  • history of choking or inhalation of a foreign body
  • child suspected or known to be HIV-infected
  • treatment given and response.

Examination

  • fever
  • lymphadenopathy (generalized and localized, e.g. in the neck)
  • wasting
  • wheeze or prolonged expiration
  • clubbing
  • apnoeic episodes (with pertussis)
  • subconjunctival haemorrhages
  • signs associated with foreign body aspiration:
    • unilateral wheeze
    • area of decreased breath sounds that is either dull or hyper-resonant on percussion
    • deviation of the trachea or apex beat
  • signs associated with HIV infection

Treatment guidelines for the most common causes of chronic cough are
indicated below:

  • Asthma
  • Pertussis
  • TB
  • Foreign body
  • HIV