Paeds Cases · respiratory-sleep-and-airway
Chronic cough in children — clinical case
Clinical case of a preschool child with a chronic wet cough illustrating the wet-versus-dry branch point, the antibiotic trial for protracted bacterial bronchitis, and escalation when it recurs.
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RACP DCEMRCPCH ClinicalABP General Pediatrics
Prompt
A 2-year-old Aboriginal boy from a remote community is brought to a regional clinic with a wet, rattly cough present most days for around eight weeks. His mother reports he is often chesty and that the cough has never fully settled since a bout of bronchiolitis. He is feeding well and tracking along the 25th centile for weight. There is no history of choking. Examination shows no clubbing and a clear chest today; a chest X-ray is reported as normal apart from mild peribronchial thickening.
Case summary
This toddler presents with an isolated chronic wet cough of eight weeks in a well, thriving child with no specific-cough pointers. The essential clinical insight is that a chronic wet cough is protracted bacterial bronchitis until proven otherwise, and that in an Aboriginal child from a remote community the threshold for decisive treatment and follow-up must be low, because this population carries a high burden of suppurative lung disease and bronchiectasis. [1] [3]
References3ShowHide
- [1]Chang AB, Landau LI, Van Asperen PP, et al Cough in children: definitions and clinical evaluation. Med J Aust, 2006.PMID 16618239
- [2]Chang AB, Oppenheimer JJ, Weinberger MM, et al Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. Chest, 2017.PMID 28143696
- [3]Wark PA, Marchant JM Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Aust, 2024.PMID 38600861