Analysis of the Literature on Chronic Cough in Children

Marcello Bergamini1, Ahmad Kantar2, *, Renato Cutrera3, Italian Pediatric Cough Interest Group4
1 Local Health Trust of Ferrara, Ferrara, Italy
2 Pediatric Cough and Asthma Centre, University and Research Hospitals, Istituti Ospedalieri Bergamaschi, Bergamo, Italy
3 Respiratory Unit, Bambino Gesù Children's Hospital, Rome, Italy
4 Italian Pediatric Cough Interest Group: F. Antonelli (Department of Pediatric Pneumology, Santobono-Pausilipon Hospital, Naples, Italy), A. Barbato (Pediatrics Department, University of Padua, Padua, Italy), R. Bernardini (Pediatric Unit, San Giuseppe Hospital, Empoli, Italy), E. Bignamini (Pneumology Unit, AOU Città della Salute e della Scienza, Turin, Italy), F. Cardinale (Pediatric Unit, Division of Pulmonology, Allergy and Immunology, AOU “Policlinico-Giovanni XXIII”, Bari, Italy), S. Cazzato (Department of Pediatrics, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy), M. Ghezzi (Pediatric Pulmonary and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy), F. Midulla (Department of Pediatric Emergency, “Sapienza” University, Rome, Italy), M. Miraglia del Giudice (Department of Pediatrics, Second University of Naples, Naples, Italy), A. Novelli (Clinical Pharmacology and Oncology Section, University of Florence, Florence, Italy), V. Ragazzo (Pediatric Unit, San Giuseppe Hospital, Empoli, Italy), G.A. Rossi (Pediatric Pulmonary and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy), O. Sacco (Pediatric Pulmonary and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy), A. Saggin (School of Management, Bocconi University, Milan, Italy), B. Tagliaferri (Department of Radiology, Melloni University Hospital, Milan, Italy), G. Tancredi (Department of Pediatrics, “Sapienza” University, Rome, Italy), L. Terracciano (Department of Pediatrics, Melloni University Hospital, Milan, Italy), N. Ullmann (Respiratory Unit, Bambino Gesù Children's Hospital, Rome, Italy), A. Zanasi (Pneumology Unit, University of Bologna, S. Orsola Malpighi Hospital, Bologna, Italy).

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© 2017 Bergamini et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Pediatric Asthma and Cough Centre, University and Research Hospitals, Istituti Ospedalieri, Bergamaschi, Via Forlanini 15, 24036 Ponte San Pietro-Bergamo, Italy; Tel: +39 035604232; E-mail:


Throughout childhood, various developmental phenomena influence the cough reflex. Among these are the modifications in the anatomy and functions of the respiratory tract and the central and peripheral nervous systems. Moreover, after birth, the immunological response undergoes progressive transformations with the acquisition of immune memory processes. These conditions make infections and airway abnormalities the overwhelming cause of chronic cough in children and infants. In children, chronic cough should be treated on the basis of etiology. The aim of this article is to provide thorough research and analysis of the medical literature published up to 2014 on chronic cough in children as a disease entity, including the epidemiologic, etiologic, diagnostic, prognostic, and therapeutic aspects.

Our results demonstrate differences in the definition of chronic cough, the characteristics of diagnostic procedures, study settings, and prevalence of the main causes. However, few studies regarding epidemiology and the quality of life have been reported. Many therapeutic approaches that are considered effective in adults with chronic cough seem to be less efficient in children. Regardless of the setting, whether pediatric or non-pediatric, children with chronic cough should be carefully evaluated using child-specific protocols and algorithms. Awareness of the various pathophysiological conditions associated with chronic cough is vital for making a correct diagnosis and providing appropriate treatment. The prevalence of the different causes of chronic cough depends on various issues. Among these are the population under consideration and its age range, infectious disease control and prevention, the diagnostic procedures employed, disease definition criteria, and the local health system. Clinical guidelines for the management of children with chronic cough should take these components into consideration. Further clinical and basic research studies are still needed for better diagnosis, treatment, and prevention of chronic cough in children.

Keywords: Chronic cough, Children, Guidelines, Cough management.