When to Treat, When to Refer

 | Dr. Sereesh N Babu
Coughing is a complex reflex involving muscles and neural pathways. While typically a healthy response, persistent or chronic coughing can signal underlying health issues.1 Cough is categorised into acute, subacute, and chronic types based on symptom duration. Initial evaluation in children includes thorough history, physical examination, chest X-ray, and spirometry. Referral to specialists is necessary for persistent chronic cough with red-flag symptoms like choking or recurrent infections.2 Management focuses on treating the underlying cause; for instance, antibiotics for protracted bacterial bronchitis and inhaled medications for asthma. Paediatric guidelines do not recommend over-the-counter medicines (including antitussives, expectorants, mucolytics, and antihistamines) for acute cough due to insufficient evidence of effectiveness.3 "1.https://www.ncbi.nlm.nih.gov/books/NBK430791/#:~:text=Cough can be divided into,weeks. 2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8804402/#:~:text=Often, a child's cough naturally,lasting more than four weeks. 3.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9860236/#:~:text=Treatment of chronic cough,The management of&text=For non-specific chronic pediatric,17, 20, 40]."