Shropshire Star

Dr Mary McCarthy: How a child's persistent cough can be diagnosed

Coughing children are a worry. Parents are anxious because they expect a cough to clear in two or three days and children are upset because it disturbs their sleep.

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It is true that most coughs will clear in time, though the time is often longer than the expected two to three days. Viral infections can take 10 days or more to resolve and whooping cough, which is mercifully rare due to an efficient vaccination programme, lasts for six weeks.

With coughs that go on for longer than this then other possibilities than an infective progress need to be considered. I remember one boy coming with his sensible mother who reported a persistent cough since Christmas. On talking to him it became apparent that the cough had started after a choking fit (that his mother had been unaware of).

He and his friends had attacked a bowl of nuts and were throwing them in the air and catching them in open mouths. One of the nuts had gone, not into his stomach but into his lungs and had remained there ever since and on listening to his chest there was a small but definite area where the breath sounds were not normal.

He had to be referred up to the hospital but most causes of cough can be dealt with in general practice. An ongoing cough in an active child needs a careful history taken from both the child and the parent and often, other investigations which can usually be carried out in the practice.

Sometimes the parent will report that she remembers a similar cough when she was a child and that she was prescribed inhalers.

A family history of asthma is a strong indication that she could be right. Extra information she gives, that the cough is worse after exercise and that her child can get wheezy occasionally makes the diagnosis almost certain.

We, like many practices, have an excellent asthma nurse, who carries out lung function tests both before and after the administration of inhalers to check on the response to medication. Inhalers used with children tend to be given with a spacer and an appropriately-sized face mask to make it easier to get the medication down into the lungs.

It seems a bit of a hassle but the instant relief makes it worthwhile. Often two different inhalers are needed, one to expand the small tubes inside the lungs and one to protect the lungs and stop them reacting to irritants.

Asthma attacks can be triggered by pet hairs, pollens, smoke as well as other irritants. Now is a good time for everyone in the house to stop smoking and to consider which pets are safest. Stress can also be a trigger so changing schools or exams may need a temporary increase in the medication prescribed. It's a condition that involves the whole family.

* Dr Mary McCarthy has worked at Belvidere Surgery in Shrewsbury for more than 20 years. She is chairman of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA.

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