Approach to Chronic Cough:

Definition:
American College of Chest Physicians – cough that lasts more than 4 weeks
British Thoracic Society – cough that lasts more than 8 weeks

Prolonged cough – at least 3 weeks and is relentlessly progressive but less than 8 weeks.

Causes:

Allergic:
1. Asthma
2. PND/AR

Infective:
1. Persistent pneumonia
2. Bronchiectasis
3. TB
4. Pertusis/Parapertusis
5. Aspiration pneumonia
6. FB
AI:
1. ILD
Fluid overload:
1. CCF
2. Nephrotic
3. CLD
Abdo:
1. GERD
Congenital:
1. Tracheobronchomalacia
2. CF/AAT/Ciliary dyskinesia

Antibiotics and Salmonella Carrier:

Antibiotic use may not result in rapid control of symptoms or stop the excretion of the bacteria
in stools. Instead it may lengthen the time period that bacteria are excreted in the stools,
thereby increasing the risk of infecting other people. Antibiotics do this by suppressing the
“protective” effects of endogenous intestinal bacterial flora, which results in recrudescence of
the hardy Salmonella species.

Chronic Lung Disease = Bronchopulmonary Dysplasia

Definition: impaired alveolar development, due to very premature birth and ELBW. New -
Characterized by fewer and larger alveoli and dysmorphic pulmonary vasculature. Old -
airway injury, inflammation, and alveolar septal fibrosis, associated with oxygen toxicity,
barotrauma, and infection. Patients who are <32 weeks GA are assessed at 36 weeks PMA
or when discharged home, whichever comes first. Patients who are ≥32 weeks GA are
assessed between 29 to 55 days of age or when discharged home, whichever comes first.
Infants who require supplemental oxygen for at least 28 postnatal days

Risk factors:
1. Prematurity
2. Mechianical ventilation  Volutrauma
3. Oxygen toxicity
4. Infection: Sepsis/Chrioamnionitis

Complication:
1. Asthma-like symptoms, central/upper airway disease, sleep hypoxia
2. PA HTN, Increased risk of respiratory infeciton