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Lung diseases

Constant cough

02/02/2010

Question:

My daughter is 4 years old. She has had a cough since October and it doesn`t seem to ever go away. We have taken her to the doctor 5 times, taken about 2 weeks off from work, tried Zyrtec, antibiotics, cold medicines, steriods, breathing treatments... I feel like we have tried everything and still she coughs all night, at nap time and when she is being active. She doesn`t wheeze or get short of breathe. I am asthmatic and it doesn`t seem the same. Is there anything we can do?

Answer:

In otherwise healthy children, the most common causes of chronic (longer than 3 weeks) cough include:

1) Chronic post nasal drip (related to sinusitis or allergies)

2) Asthma (even if no wheeze has ever been identified)

3) Gastroesophageal reflux (even in the absence of other signs, like heartburn)

There are additionally many less common causes for chronic cough, ranging from having an aspirated toy or piece of food stuck in the airways, to a problem with a structurally abnormal lung segment becoming infected - and being difficult to treat, to having an unusual infection that routinely used antibiotics don't treat.

It sounds like her doctor has already tried some therapies aimed at post nasal drip issues and asthma. Testing or a trial of medication for reflux would be a reasonable next step. Further studies may be needed as well, especially if reflux doesn't seem to be the answer. If not done yet, a chest x-ray would be reasonable - if there are any abnormalities, that would point in the direction needed for further tests/treatments. It may be time to ask for a referral to a pulmonary specialist to help direct some of this testing for "rarer" conditions, and to help make sure the more common ailments have really been completed ruled out. 

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Response by:

Elizabeth D Allen, MD Elizabeth D Allen, MD
Clinical Associate Professor of Pediatrics
College of Medicine
The Ohio State University