Defining the Cough Spectrum and Reviewing the Evidence for Treating Non-Specific Cough in Children

Cough is the most common presenting symptom to medical practitioners to the USA and Australia. Worldwide, the desire to reduce the impact of the symptom of cough is reflected in the billions of dollars spent on over the counter cough medications. Easy to apply and clinically relevant definitions of cough are necessary for effective communication and to progress clinical research. Based on current data, pediatric cough definitions have been formulated on timeframe (acute and chronic), clinical cough characteristics (dry vs wet/productive and classical recognizable cough sounds) and suggestive broad underlying etiology categories (expected cough, specific cough, non-specific cough and protracted bronchitis). These definitions are distinct from adult definitions, as many of adult-type aspects of cough cannot be applied to young children. With the lack of pediatric data, adult data is often inappropriately extrapolated to children. In the second part of this paper, the evidence for and against the use of the various pharmaceuticals (such as OTC medications, antimicrobials, treatment for gastroesophageal reflux and asthma) for cough in children are reviewed. The utility of 'time to response' is important in the management of cough in children to minimize possible associated morbidity of the therapies for non-specific cough.