By vgreene, 23 September, 2020 If eval negative: Watch, wait, re-eval in 2wk, per ACCP1 (up to 4wk, per ERS2), then follow to resolution1
By vgreene, 23 September, 2020 Consider DDx.1 Nonspecific dry cough usually postviral cough or acute bronchitis. Test for pertussis if suspected3 (posttussive vomit, paroxysms, inspiratory whoop).1 Don’t routinely allergy test w/o s/sx allergies,2 though may be useful if dx uncertain o
By vgreene, 23 September, 2020 Consider COVID 19 x2713 CXR x2713 spirometry1 2 3 6 yo 1 in pts w o specific cough pointers1 from hx exam tests cough type 1 triggers 2 x2713 tobacco smoke pollutants child activity level parental concerns 1 Nonspecific cough more likely to resolve w o sp
By vgreene, 23 September, 2020 Consider COVID-19. ✓ CXR, ✓spirometry1,2 (3-6+ yo),1 in pts w/o specific-cough pointers1 from hx/exam/tests/cough type,1 triggers.2 ✓tobacco smoke/pollutants, child activity level, parental concerns.1 Nonspecific cough more likely to
By vgreene, 23 September, 2020 Consider COVID-19. ✓ CXR, ✓spirometry1,2 (3-6+ yo),1 in pts w/o specific-cough pointers1 from hx/exam/tests/cough type,1 triggers.2 ✓tobacco smoke/pollutants, child activity level, parental concerns.1 Nonspecific cough more likely to
By vgreene, 23 September, 2020 For unexplained cough after comprehensive eval: Therapy for somatic cough disorder8,9 (aka, habit/tic/psychogenic) lacks evidence in children. Reassurance, psychotherapy, counseling, suggestion tx, hypnosis, etc, have been suggested2
By vgreene, 23 September, 2020 Don’t use OTC cough meds, d/t adverse event risk, insufficient evidence of benefit. Honey may help cough (avoid
By vgreene, 23 September, 2020 Don’t empirically tx UACS/post-nasal drip from sinus dz (controversial pedi cause), GERD (rare pedi cause5), or asthma unless clinical features beyond cough present.1,5 Set time limit on tx trials.1 Post-acute viral bronchiolitis cough: Don’t use asthma d
By vgreene, 23 September, 2020 If tx trial chosen, f/u in 2-4wk. If sx resolving, consider asthma or asthma-like dz, f/u in 2-4 more wks; then stop steroids if no other asthma features.1 If sx persist on tx trial (after 4-8-wk steroid trial, per ERS2), stop inhaled steroids,2 re-eval f
By vgreene, 23 September, 2020 If cough persists @ 2-wk re-eval: Re-✓ for specific-cough s/sx.1 If none, then either watch/wait x2 more wks or consider inhaled steroid 2-4-wk tx trial1,2 (budesonide 400 ug/day or equivalent)1
