The office is flooded with fevers, colds and coughs. So, many parents choose or are given advice to just wait it out. The cold will pass. While it’s true that many viruses can cause a persistent cough, long lasting symptoms can sometimes be a signal of reactive airway disease or asthma.
A cough is often a generic symptom that can be involved in many acute and chronic illnesses. As parents go through more illnesses with their children, it may be more clear that a cough is actually a wheeze or stridor. But these definitions come with experience and visits to the physician. Usually, sick time is at least one factor a parent and physician can note to see if a cough may actually be related to another illness, whether it be underlying or secondary to a recent infection.
Most viral related coughs evolve over several days to a week and resolve over a 10-14 day course. There are always exceptions, but this is a good rule of thumb to start with. In contrast, some children start with what seems a regular cough but the child just doesn’t seem to be able to get over it. Oftentimes, these children come into the office and seem active, but either have a dry cough, are wheezing, or have a crackling sound to their lungs. As pediatricians, we ask about how long the cough has been going on, when it is worst, anything that makes the cough better or worse, and whether or not there is a family history of allergy or asthma.
Depending on the answers to these questions, we may do a trial of nebulized albuterol in the office to assess a child’s responsiveness to a bronchodilator. If a child sounds remarkably better, a nebulizer or inhaler may be sent home with the family and a recheck is always recommended.
If this is a first episode of such a course for the patient, the pediatrician and family expects a quick resolution and it’s possible that no other diagnoses may be discussed. However, if this is the third or fourth episode requiring a medication or associated with a prolonged cough, reactive airways may be discussed, which can, when repetitive amount to asthma. We will talk about this subject in a subsequent article. Sometimes a cough isn’t just a cold.