Chronic and recurrent cough

1.Bronchitis In the majority of patients with recurrent cough the cause is asthma or bronchitis. The main characteristics are episodic cough, usually associated with bouts of fever and malaise and in asthma with wheezing. It is unusual for sputum to be produced. Clinically the signs may be inspiratory and expiratory rhonchi and coarse crepitations but often the chest will be clear. Radiologically the hilar regions are prominent and bronchovascular markings increased, and there is no evidence of parenchymatous involvement. 2. Suppurating lung disease In this group of patients the cough is persistent and the patient is never free of cough. Purulent sputum can usually be produced if the child is postured and taught to cough and expectorate. Often there will be few signs in the chest, usually no more than a few crepitations. Radiologically there will almost invariably be parenchymatous involvement, either lobar, segmental or lobular collapse or pneumonic changes 3. Focal lesions A pathological lesion in the lumen, or wall, or which presses on or infiltrates the bronchial tree may cause a persistent dry cough by irritation of the sensitive receptors. The cough is usually unproductive and sounds dry. Secondary infection consequent on obstruction of the bronchial lumen is not common. Stridor or wheezing may be associated with the cough if the larynx, trachea or larger airways are significantly narrowed. Most of the lesions are relatively uncommon and their nature will only be determined by special methods using radiology and endoscopy 4. Nervous or psychogenic cough The two principal features are overt or covert parental anxiety about the child's cough and lack of any evidence of underlying respiratory disease