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Management of persistent respiratory symptoms in pre-school children.
Recurrent wheeze and cough symptoms affect 13% of children under 5 years of age. Triggers include:
Bronchiolitis can cause airways hyper-reactivity and respiratory symptoms for many years. Whilst the majority of these chidren do not have an increased risk of asthma or allergy in later life there is a progression from childhood from wheeze symptoms to adult asthma in some children.
Controversy and confusion exists over which treatments are effective in managing recurrent wheeze and coughs in pre-school children.
Chronic cough
Differential diagnosis of recurrent wheeze and cough in pre-school children:
Features suggestive of underlying lung disease:
Recurrent lower respiratory tract infections – See Management of Community Acquired Pneumonia pathway
Initial assessment
Children with chronic cough with worrying features
Refer to the on call Paediatrician
Once a child has been referred to the on call Paediatrician, investigative tests will be carried out to advise on case by case management plans to be followed up in primary care with the GP.
Treatment plans:
Treatment plans are largely supportive. Parents should be advised
Follow up includes:
Children commenced on any of these treatment strategies should be reviewed at 6-8 week intervals to assess progress. Ideally, this period of treatment should include an upper respiratory tract infection to assess effectiveness of treatment.
Where these treatments are felt to produce no improvement in symptom control or are poorly tolerated, then they should be stopped and another treatment trialled for a further 6- 8 week period of time.
Parents should be advised to return to their GP if there are increasing concerns and a low threshold should be maintained for onward referral to the paediatric respiratory team.
Cessation of parental smoking has been shown to be a successful therapy for respiratory symptoms in children.
Children with chronic cough with worrying features
This guideline has been signed off on behalf of NHS Devon.
Publication date: February 2017