Chronic Cough Treatment for Children – Mindy Ross, MD | UCLA Mattel Children's Hospital



hi welcome back I'm pediatric pulmonologist dr. Mindy Ross you may have caught my previous webinar about the evaluation of chronic cough and today's talk continues from there and is about the treatment of chronic cough so if you have any questions please tweet them or comment on the Facebook live stream the outline of the talk today will be to go through a quick review again about the definition of chronic cough we'll discuss options for treatment of chronic cough including home remedies medications and prevention and then finally we'll review when and why to visit a pediatric pulmonologist so first up why do we call we call – for many reasons we cost to protect our air away from irritants we cost to clear the mucus we make on a daily basis and the extra mucus we have when we're sick and coughs can be an early warning sign of disease and the how of how do we cough we have many cough receptors in our body this picture here the dots show where they all are strategically located throughout the airway and their job is to sense irritants and send signals up to the brain and since that sends signals back to the body to produce that cough and so the definition how do we know when a cop is chronic the definition of chronic cough is based on time and for comparison and acute scoff or a shorter term cough is one that lasts for a month less than a month and these are usually caused by viral illnesses the symptoms last seven to fourteen days and in a ninety percent of the cases the symptoms in the cough goes away on their own but the coffee is called chronic if it's coughed last for more than a month there are some viral illnesses that cause a coughed that lasts for more than four weeks but the pediatric community uses is cut off to make sure we're not missing any more serious underlying conditions so when the cost comes chronic if it affects daily functioning or is associated with any other health problems then this is when we become concerned and start looking for causes other than viral illness and discovering the cause of the chronic coughs can be challenging because there are many causes first up on listing the more common causes that we're looking for and this is asthma foreign body in the airway or even in the ears that can trigger those cough receptors gastrointestinal issues can actually cause chronic coughs this would be gastro esophageal reflux or GERD where food is coming up towards the airway and irritating and causing coughs or people can children can have trouble swallowing and food can go towards their airway also there is a tick off and then they could be habit coughs how the cost is some a cough that's often starts as a viral illness but over time the cough receptors become more sensitive and it turns into this vicious cycle of this harsh honking loud cough and actually can the the habit cost can go away sometimes fairly quickly with specialized therapy and cost biofeedback and then also there are infections that can cause chronic cough a variety of them bacterial sometimes viral and then there's something called the upper airway cough syndrome formerly known as post nasal drip and this is actually caused by underlying issues such as allergies sinusitis irritants such as smoke or sometimes the tissue in the upper airway called the adenoids can be large and cause congestion and we took off post nasal drip and cost and there are many there are other common causes that are less common and these often are conditions that children are born with sometimes there are some acquired causes such as lung damage after an infection or because of some of the other conditions and unfortunately there can be tumors so we have to be aware of such as that and that's why it's important to involve a pediatric pulmonologist because there are so many causes we're trained to identify and treat and manage them so next up I'll review the treatment for the chronic cough before I get into the details just a couple words about the expectations when we're treating a chronic cough and I wanted to get the bad news out of the way first so there's not always a quick fix to treat chronic cough unfortunately the mainstay of treatment is symptom management close monitoring and reassurance and also the chronic cough can be very frustrating it's leads to poor sleep and children sometimes missed school work for parents and sometimes even the coughs becomes chronic and it's on some point it's not contagious anymore the children may get sent home from school and you know it's also frustrating for health care providers because we all really want to get rid of this cost very quickly and sometimes it's just not possible but then the good news the good news is that the cause of the cough usually will be found this may take thorough evaluation and frequent followup with the pediatric pulmonologist but the cause is usually discovered and many times the cost will go away depends on the underlying cause of what's causing the cough and the good news is that we're here pediatric pulmonologist for you and experts exist in this field who are trained to help treat chronic cough so then first up which is what oh I know a lot of people are interested in our home remedies and things we can do at home that don't involve prescription or medication and the one caveat for this is that the home remedies they aren't usually specifically for chronic coughs they're often for colds or viral illnesses the acute cough but I'm mentioning them here because as long as they don't cause harm they can be used often as was an adjunct or in addition to a treatment for the chronic cough and if the cough doesn't improve or it's getting worse with things you're trying at home please seek medical attention right away and so first up is nasal saline rinse and this acts as a decongestant and can help with cost that's caused from post nasal drip and and in younger kids they'll need the saline drops and some bulb suctioning and older kids will be able to blow their nose and this these saline rinses can be done as often as you think your child needs them throughout the day just be careful to avoid irritating the nose with the suctioning and next is honey so honey has actually been studied and it's been shown that it can decrease the coughing for children at night and also help children get better sleep and as well as the parents can sleep better too and the actual mechanism of this isn't known of why it works there's a lot of theories it's thought that it can coat or smooth the throat it's also thought to have antibacterial properties antioxidant or anti-inflammation properties as well it's also thought that it can make more saliva and this can trigger nerve since nerve receptors by the tongue that can decrease activation of cough but nobody really knows but it has been shown to have some effect and the other big butt about honey is that it is not recommended do not give it to children who are under a year old and this is because they're these younger children are at risk for a toxin that can be found in honey that can cause infant botulism and this is a life-threatening condition so children under 1 do not get honey but if they're old enough then you can give toddlers and younger kids half a teaspoon at night and older kids can get one to two teaspoons and next is always as very common you'll hear this is to drink liquids and stay hydrated this is because you know when you're hydrated also the mucus layer in your body in your airway is hydrated – so the mucus is more thin and less sticky and can move out of your Airways better when you cough we actually want the mucus to move out of your airway and also involving fluids are to drink warm flavorful liquids and we have to say and this is thought to loosen secretions but your elders were right that that chicken soup or the tea with lemon can have an effect on cough and help it in theory and yet spot to loosen secretions and also may stimulate some receptors near the tongue that can decrease coughs activation and then also some records some therapies that are commonly recommended but have not been studied as much as the others that I mentioned are the cool mist humidifier and so this can put mist into the air and humidify the airway and hydrate the only issue or risk with this is for people who have allergies because the equipment is at risk for a growing mold or fungus so the thing to remember is to clean the equipment regularly and keep it in a well ventilated area and if the cough is worsening or symptoms are worsening or it's not working then stop the therapy the other one is cough drops this is for older children and the thought or lozenges they're also called and these are thought to be able to soothe and coat the airway and also for people with habit cough it can help distract them from coughing and again the risk with this one is that it can be a choking hazard so just be careful that when children are using the throat lozenges are upright and they're not laughing or things like that so we always want to think of risks and benefits of all the treatments that we give the other thing people it's not on here but people wonder about is the vapor rub aromatic vapor rub on the chest that's more that's not educated for chronic cough people do try to use that for the acute short-term cough and nasal congestion that has been shown to relieve the sensation of nose congestion and people but because there are risks of rash and if people use it incorrectly it can actually worsen breathing symptoms so it's and it's not recommended in chronic cough and the next step I'll talk about medications you can use so first the over-the-counter medications unfortunately these are for the coughs and cold therapy and cough suppressant medications these are not recommended and children under six years old and they're not encouraged in children's children under 12 years old either this is they're not encouraged for acute or chronic cough and this is because research has shown that they are not much more effective than doing nothing or placebo and there are many reports of toxic side effects so nausea dizziness seizures short pauses problems breathing and there have been cases of overdose and death so because of all those things again we're weighing the risks and benefits of all the therapy we use risks of using these medications with side effects versus the benefits which might not be as high so they are not recommended in young children and even for older children who can take the medicine there's still these considerations of side effects so if your child is using the medicine and then any side effects are not working please stop the medication immediately and also a quick note on the medications that suppress coughs this would be such as dextromethorphan that's found in robitussin or Delson or some brand names we often we don't recommend those either because of the side effects but also again we really encourage cough because that's what's helping to clear the mucus and if mucus is stuck down in the throat it can actual you're in the airway it can actually lead to more problems and infection so we do want people to clear the mucus and so there are there are medications that are very targeted towards certain causes of chronic cough and that's what I'll talk about next the first one is asthma and asthma is a condition that's often under-diagnosed and undertreated so with the chronic cough if your child has any other signs that suggest asthma wheezing triggers that are common for asthma or lung functions testing that suggests it they will be started on a trial of asthma controller medication and usually by the time they they end up at the pediatric pulmonologist the symptoms have been going on long enough and are often enough that they will need that daily control or medicine medication instead of an as-needed medication and this is the inhaled corticosteroid which is the inhaler slow acting medication to help calm down the inflammation in the airways and prevent it from becoming worse with triggers or illness and other medication there are medication by mouth that our asthma controller medications as well or the oral steroids if the cough is very bad and affecting your child greatly there will be put on a five day course of oral steroids to help calm down the symptoms and the important thing to remember if you have an inhaler for asthma is you have an asthma medication inhaler to always use the chamber or spacer with it because this helps the particles be delivered properly down into the lungs instead of without it it's oftentimes squirted more into the mouth and swallowed so the space is very important because you're using medications but we have to make sure they're being used properly the other candidate another condition is allergies that there's specific treatment for and these medications are called antihistamines some brand names are der tech claritin Allegra and they help block this molecule called histamine which causes all the allergic response in the body and there's also some nasal corticosteroids sprays that can be used every day they're slow acting they also help to calm down the inflammation such as flonase or Nasonex and those might be trialed as well the other condition – that has specific treatment is gastro esophageal reflux or GERD and this as I mentioned before when the food comes up or the acid can trigger coughs and wheezing and so there are medication like zantac or prilosec that can help suppress or block the stomach acid there's also medication that helps the gut move so the food stays down and doesn't come up towards the airway but both of these conditions you may have a trial of the treatment or you may be end or you may be referred to a specialist for treatment and further medication choices or testing or evaluation and then the lastly a specific condition that might be causing the cough and how the treatment would be bacterial infections and the treatment for this is antibiotics and there are many different types of infections out there so sometimes the recommendation will be a certain type of antibiotic for days and sometimes it will be months so the key is to have close guidance with your physicians and to come up with the proper diagnosis and we really want to avoid over prescribing of antibiotics so before you're started on the antibiotics or might be other testing that's done first and the key is if you are prescribed the antibiotic make sure that you complete the whole course and then next up on the treatment we put them putting prevention because that's always number one if you can prevent getting a coughs that's the best or if you can prevent irritating your coughs up is great – this is the first one I have on the list to avoid the triggers that worsen cough there is tobacco smoke or allergens if you have allergies or asthma also important is not catching cough or sharing germs with others so always remember the good coughs hygiene to cover your mouth not with your hand which you touch people and things with your hand after you sneeze but cover your mouth with your elbow like this and coffee here and also remember good hand-washing and also there are options available in terms of vaccines for some conditions that are known to cause chronic cough such as pertussis which causes the whooping cough and also the flu vaccine can prevent influenza and that's more known to cause long-term lung damage so if we can prevent that that is wonderful – and lastly when and why to visit us the pediatric pulmonologist so the wind it's a cost if your child's cough is lasting more than a month please come see us if the coughs if it's been less Inlet but the cough is worsening or if there are any red flag symptoms or other symptoms that are going along with the cost that seems more than a viral illness and that would be if your child has any weight loss other infections also poor growth or any other concerns that you may have and the why why visit pediatric pulmonology we all have years of extra training in pediatric lung disease and when you come into the clinic we have specialized lung function testing that's performed by respiratory therapists or experts and they're very familiar with performing these tests with children there are comprehensive symptom evaluation surveys and intake forms that we have and I think really important is that we are a multidisciplinary team with a big team approach we have respiratory therapy certified pulmonary nurse specialists dieticians social work and everyone's trained to teach and provide you with the best knowledge that we can about pediatric lung disease and so here is our contact information you can always go online and look us up UCLA pediatric pulmonology and in summary for chronic cough chronic cough is treatable and there are many treatment successful treatment options the treatment depends on what we think is causing the cough and when the cough is chronic we strongly encourage evaluation by a pediatric pulmonology because we can provide testing monitoring and close follow-up and that's it and if you have any questions please tweet and I will answer some questions you all right is there a treatment for wet versus dry cough that's a good point so the the treatment that we choose is usually based on what we think is causing the coughs not exactly what the cost sounds like but the sound of the cough can give us some clues so the wet cough will make us think more of the gastro esophageal reflux of food coming up or post nasal drip or one of the possibly congenital lung diseases that makes it more difficult to clear mucus whereas the dry cough may make us think more of asthma or a foreign body but it's not always a hundred percent the sound of the cough what if I don't bring my child to the doctor for a chronic cough yeah yeah we all do hope that coughs go away but a lot of times the chronic cough is more than just a viral illness so we want to treat and identify that underlying cause of the cough as soon as we can and this is so we can prevent any lung damage long term long damage or like I mentioned there if there's something like a lung tumor we want to identify that as soon as possible and treat it right away can the color of phlegm color of the phlegm tell me anything about the cause of the cough and like the sounds of the color the phlegm doesn't tell us exactly what's causing the cough but there can be hints of clues of conditions going on like a yellow or green phlegm can mean an infection viral or bacterial so it can't doesn't we can't tell the difference between those clear clear phlegm can be more like viral illness potentially or allergies and brown or red phlegm can mean something like blood and and what about air filters for chronic coughs and that's good I didn't mention that on the air filters they have been studied and there is mixed evidence on that and that's mixed evidence whether it works or not but it's that people have allergies to animal dander dogs and cats it seems like the air filters can help we won't say don't try them so we always would say try them they can be expensive but welcome to try them and if they help that's wonderful but we can't say that we would guarantee that there would help the cough and I think that's it so thank you for joining me today and you can check out our groups other pulmonary webinars on our website and have a great day you

23 Comments

  1. I got a cough about 2 weeks ago I also usually cough up green gooey flem

  2. I have asthma and every time I talk this cough gets stuck when I talk

  3. Fuck off lady

  4. Hi I keep having cough attacts

  5. Hiiii I am 24 year old and I am suffering from feaver and cough and cold every month or when ever weather change.. It's feel very bad how can I remove this chronic disease

  6. Got sick last year near the end of summer, been coughing since. It was going away and then I got sick again now I'm coughing a lot again. Yeah.. I needa get checked up

  7. I can't breathe when I cough

  8. my little daughter had cough and she is still suffering from it , this makes me feel sad , so what I gona do

  9. I have a cold and cough

  10. My beby 3 years old are drikng water then cough .
    y are cough fing. what is the problum

  11. Regarding the over counter medications, cough suppressants. This woman is saying the risk of side effects have been overdose and death. so why they heck are they still available to purchase.. especially as they are, as she said, no better than home remedies???

  12. Those damn immigrants giving me a chronic cough now

  13. I been sick for a week and half and this is piss me off cuz I cannot sleep and I pee myself cuz of the couching and dry cough too this is driving me nuts.

  14. Comprehensive presentation on cough.

  15. I’m sick and I’m coughing and my chest hurts

  16. Very informative video. cough can be treated naturally through Ayurveda. Tulsi Capsules and Pranrakshak Churna of Planet Ayurveda are very useful in treating cough.

  17. Hi Mindy u are very sweet n beautiful. Love

  18. I dont wana die…..

  19. how would i know if my cough is caused by bactria or virus?

  20. I am really cold and when I cough my throat hurts a lot

  21. Vitamin c liquid works on my child, age 6

  22. My fucking throat i feel like i have lung cancer i cant ignore it and after i am done my throat feels like bleeding

  23. I've been coughing in almost a year
    Whenever I get exited or happy I cough but it stopped for like three months and now it's different it won't stop

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