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Latest revision as of 21:03, 24 February 2021

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S [2]

Synonyms and keywords: Cough in kids

Overview

Cough is a common complaint of the pediatric population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of respiratory airways. The word 'Cough' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, anatomical location, etiology and grades of coughs. Stimulation to cough receptors provokes sensations of coughing through the afferent pathway via the vagus nerve, central respiratory centers in the upper pons and medulla, and efferent pathways via the phrenic and vagus branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of physical examination, laboratory, and imaging investigations. Some of the causes are emergently managed to reduce the mortality of a child.The mainstay of therapy for cough is supportive. Antihistamine, antitussive medications and nasal decongestant are provided for alleviating symptoms of acute cough. Allergic conditions are treated with steroids.

Historical Perspective

The word cough was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.

Classification

Cough in children may be classified or defined according to the duration of presenting complaints, quality and sound, and causes of cough into several groups.^[1]:
1 Duration of Presenting complaints: According to the duration of cough, it can be sub-classified into three categories:
- Acute: < 3 weeks.
- Subacute: 3 to 8 weeks.
- Chronic: > 8 weeks.

2. Nature or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
- Dry or Hacking or Nonproductive.
- Wet or productive cough.
- Staccato or short repetitive cough.
- Whooping or paroxysmal violent or spasmodic cough.
- Barking cough: Brassy barking or Honking barking.
- Phlegmy cough.
- Burning cough.

3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
- Specific cough.
- Nonspecific cough.
- Expected cough or Normal cough.

4. Anatomic classification on the causes of a cough: A cough can be produced from different anatomical locations. For example:
- Nose and Paranasal sinuses.
- Pharynx.
- Larynx.
- Trachea and Bronchi.
- Pulmonary parenchyma.
- Pleura.
- Mediastinum.
- Heart and blood vessels.
- External ear and Tympanic membrane.
- Esophagus.

5. Grades of cough: Cough can be graded into four main sub categories:^[2]
- Eutussia or Normal.
- Hypertussia or Sensitized.
- Hypotussia or Desensitized.
- Dystussia or Pathological.
- Atussia or Absent.

Cough in children can also be classified under infectious (Bacterial, Viral, fungal, Parasitic) or non-infectious categories broadly.

Pathophysiology

A cough is a natural innate primitive reflex that helps in mucocilliary clearance of foreign particles and secretions from respiratory tracts. It is also a defense mechanism protecting the respiratory airways from aspiration of pathogens, particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the cough reflex.^[3]

Mechanical and chemical stimulation of cough receptors (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in Respiratory airways

Afferent pathways: Sensory nerve fibers via Vagus Nerve from ciliated columnar epithelium of upper airways, cardiac and esophageal branches from diaphragm send impulse to central cough center

Central cough center in upper brain stem medulla and pons send impulse of sequence of phases (Inspiratory, Compressive, Expiratory) for constituting cough

Efferent pathways: The nucleus retroambigualis sends impulse via phrenic and spinal motor nerves to diaphragm and abdominal and respiratory muscles, the nucleus ambiguous sends impulse to larynx by laryngeal branches of vagus nerve

On gross pathology, bloody, serous , mucoid, rusty, pink frothy, and purulent are characteristic findings of sputum produced by coughing.
On microscopic histopathological analysis, pathogens, RBCs, leukocytes, epithelial cells are characteristic findings of sputum produced by coughing.

Causes

Causes of cough in children according to duration^[4]^[5]^[6]:

Cough

Acute(<3 weeks) •Common Cold
•Allergic Rhinitis
•Bronchitis
•Bronchiolitis
•Asthma
•Whooping Cough
•Influenza
•Croup or Tracheolaryngobronchitis
•Pneumonia
•Irritation by smoking
•Foreign Body
•GERD

Subacute(3-8 weeks) •Whooping Cough or Pertussis
•Post infectious Cough
•Bacterial Sinusitis
•Asthma

Chronic(>8 weeks) •Upper Airway Cough Syndrome
•Asthma
•Bronchiectasis in Cystic fibrosis and Kartagener Syndrome
•Chronic sinusitis
•Malacia
•Foreign Body
•Nonasthmatic eosinophilic bronchitis
•Respiratory environmental toxins

According to quality and sound of cough in children, the causes can be classified according to the following chart:

Dry or Hacking or Nonproductive

Sinusitis, Tonsillitis, Pharyngitis, Allergic Rhinitis, GERD, Asthma, Environmental exposure to irritants(pollen, dust, mites, smoke), Post infectious cough.

Wet or productive cough

Cystic fibrosis, Bronchiectasis, Bronchiolitis, Tuberculosis, Rhinitis, Postnasal drip, Pneumonia, Emphysema, Acute bronchitis, Asthma

Causes of Cough based on Nature or quality and sound

Staccato or short repetitive cough

Chlamydia pneumonia

Whooping or paroxysmal violent or spasmodic cough

Pertussis

Barking cough

•Brassy barking: Croup, Tracheomalacia, Laryngitis, Tracheitis
•Honking barking: Psychogenic cough , Tourette syndrome (habit cough)

Stridor

Viral Croup, Epiglottis, Bacterial tracheitis, Retropharyngeal and peritonsilar abscess

Burning cough

Bacterial Bronchitis, Irritants

Based on anatomical location the causes of cough in children can be demonstrated in the following chart:

Nose and Paranasal sinuses

Rhinitis, Foreign Body, Sinusitis, Nasal polyp, ppHypertrophied inferior turbinate]]

Pharynx

Pharyngitis, Foreign Body, Irritants

Larynx

Laryngitis, Epiglottis, Tonsillitis, Laryngomalacia, Subglottic stenosis, Foreign body

Trachea and Bronchi

Tracheitis, Croup, Bronchiolitis, Bronchiectasis, Bronchitis, Cystic fibrosis

Causes based on anatomic location

Pulmonary parenchyma

Pneumonia, Tuberculosis, Environmental toxin, Respiratory distress syndrome, Aspiration syndrome, Hypersensitivity Pneumonitis, Connective tissue disease, Alveolar capillary dysplasia, Neuroendocrine cell hyperplasia of infancy, Medications, Mutations causing surfactant dysfunction, Emphysema

Pleura

Pleurisy, Pneumothorax, Hemothorax, Parapneumonic effusions, Pleural tuberculosis, Congenital hydrothorax and chylothorax

Mediastinum

Mediastinitis, Mediastinal Tuberculosis, Thymoma, Thymic hyperplasia, Thymic carcinoma, Neuroblastoma, Ganglioneuroma, Non Hodgkin lymphoma, Sarcoma, Mature teratoma, Endodermal sinus tumor, Hemangioma, Wilms tumor, Lymphangioma

Heart and blood vessels

Congenital heart disease, Myocarditis, Heart failure, Cardiomyopathies, Wegener granulomatosis, Valvular heart disease, Vasculitis, Arteriovenous malformation

External ear and Tympanic membrane

Otitis media and externa, Impaction of foreign body, wax, Myringitis

Esophagus

GERD, Tracheoesophageal Fistula

Differentiating Cough from other Diseases

Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight loss	Fever	Dyspnea	Physical Examination	Lab findings	Imaging	PFT	Gold standard
Respiratory	Upper airway diseases	Epiglottitis^[7]^[8]	Abrupt or acute	12−24 hours	−	−	−	+	+	Ill appearing child in Tripod posture Inspiratory Stridor Hoarseness / Hot-potatoes or Muffled voice Drooling, Tachypnea, Tachycardia Cervical lymphadenopathy, Erythematous pharynx and larynx	Elevated white blood count in CBC Blood culture may show bacterial growth Epiglottal culture in intubated patients may show bacterial growth	Enlarge epiglottis (>8 mm), loss of vallecular air space and distended hypopharynx as known as 'Thumb print' sign on lateral neck X−ray may be helpful	Normal function	Direct visualization of erythematous and edematous epiglottis	Tripod posture Drooling Tenderness of the anterior part of the neck Etiology: Haemophilus influenzae
		Croup^[9]	Acute	3−5 days	+	−	−	+	+	Stridor Crackles	Leukopenia	Subglottic narrowing (steeple sign) in postero−anterior radiograph chest	Decreased tidal volume	Clinical diagnosis. Laboratory findings and imaging are not necessary for diagnosis	Barking cough Etiology: Parainfluenza virus type 1 (most common)
		Pertussis^[10]^[11]	Acute	Two weeks	+ Whooping sound	−	+	+	+	Clear chest	Polymerase chain reaction (PCR) shows Bordetella pertussis Serologic testing	Atelectasis may seen on chest imaging Lymphadenopathy	Normal function	Culture	Etiology: Bordetella pertussis Phases: Catarrhal, paroxysmal and convalescent
		Common Cold^[12]	Acute	3−10 days	+	−	−	+	−	Rales Wheezing	Bacterial culture is not indicated	Chest X−Ray in patients with signs of consolidation	Normal function	Clinical diagnosis	Conjunctival injection Nasal congestion
		Tonsilitis^[13]^[14]^[15]	Acute or Acute Recurrent, Chronic	Varies	+(Mucus from inflamed tissue)	−/+	−	+	Odynophagia, Tachypnea	Stridor Hoarseness of voice/ Dysphonia Cervical Lymphadenopathy	Rapid Antigen Detecting Test Throat Swab Culture EBV Heterophile Antibody Test Monospot Test Complete Blood Count	Chest X−Ray shows normal finding. USG may show Peritonsillar abscess.	Normal function	Rapid Antigen Detecting Test	Etiology: Rhinovirus, Adenovirus, Respiratory Syncitial Virus, Influenza Virus, Corona Virus, Group A streptococci
		Seasonal Influenza^[16]^[17]	Acute	Upper respiratory tract symptoms with fever peaking at three to four days, resolved by seven to ten days.	−	−	−	+(High grade)	+	Fussiness, Vomiting, Diarrhea, Myalgia, Focal wheezing, Rales, Tachypnea, Tachycardia, Retractions, Seizures	RT−PCR Virus culture Rapid Influenza diagnostic test Immunofluroscence-Direct or indirect Antibody testing	Reticular or reticulonodular opacities in chest X−Ray	Normal function	Clinical diagnosis	Etiology: A or B Influenza virus
		Sinusitis^[18]^[19]	Acute, Subacute, Chronic, recurrent	Acute: < four weeks Subacute: four−twelve weeks Chronic: > twelve weeks Recurrent: > four episodes / acute episode of rhinosinusitis yearly.	+	−	−	+	+	Restlessness, Nasal Congestion, Post Nasal Drip, Facial Pain, Rhinorrhea	In complicated acute bacterial rhinosinusitis, endoscopic cultures or sinus aspirate is indicated Nasal culture may also be helpful	Air−fluid level, mucosal edema and bony erosion of sinus on CT MRI for distinguish the etiology	Normal function	Clinical diagnosis: Nasal congestion and Post Nasal drip , obstruction, and purulent rhinorrhea	_
Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight loss	Fever	Dyspnea	Physical findings	Lab findings	Imaging	PFT	Gold standard
Respiratory	Lower airway	Asthma^[20]^[21]	Chronic	Years	+ Clear mucoid or yellow sputum	−	−	−	+	Wheezing (expiratory) Rales Rhonchi	Eosinophilia Total serum IgE in test for allergy may be helpful	Normal airways in chest X−ray CT if there any abnormality in chest x−ray	FEV1/FVC ratio <70% and FEV1 >15% increase after 15 minutes of 2 puffs of beta 2 sympathomimetic drug After physical active FEV1 decreases by >15% After inhaled corticosteroid (ICS)FEV1 increased by >15%	Airflow limitation on spirometry	Family history Seasonal variation
		Bacterial Protracted Bronchitis^[22]^[23]	Chronic	At least four weeks	+(Purulent)	−	+	+/−	+	Wheezing Rhonchi	Sputum culture is not indicated PCR in bacterial infection may be helpful	Chest x−ray to exclude other diseases	FEV1 < 80%	Clinical diagnosis	Majority of cases are caused by Streptococci Pneumoniae, Hemophylous Influenza, Staphylococcus aureus
		Bronchiectasis^[24]^[25]^[26]	Chronic	Months to years	+ Mucopurulent sputum	+	−	−	+	Crackles Wheezing Shortness of breath Chest Pain	Complete blood count (CBC) Sweat Test, CFTR Gene analysis Ciliary motility test, Nitric Oxide Test, Ciliary structures, Genetic Testing IgG, IgM and IgA Sputum culture for fungi, bacteria and mycobacteria	Linear atelectasis and dilated airways in chest x−ray Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.	FEV1/FVC <70% Normal FVC Low levels of FEV1	CT of chest	Digital clubbing Recurrent pleurisy
		'Foreign body aspiration^[27]^[28]^[29]	Acute	Sudden Onset	+	+/-	−	+/-	+	Wheezing, Inspiratory or Biphasic Strioor Unilateral Decreased breath sounds Cyanosis	No specific tests	Hyperinflated lungs, atelectasis, and mediastinitis Shift in chest radiograph when the object is radio−opaque CT may be helpful	Not specific	Bronchoscopy	In children <1 year Organic materials in children
		Bronchiolitis^[30]^[31]	Acute	8−15 days	+	−	−	+	+	Rhinorrhoea Cyanosis, Hypoxia Intercostal and subcostal retraction Tachypnea Wheezing Crackles Grunting and Nasal Flaring	Complete blood count (CBC) may be helpful Urinalysis & urine culture ( in infants)	Chest x−ray may be helpful	Normal function or obstructive changes (FEV1/FVC <70%) Air trapped in Lungs Decreased Diffusing capacity of Carbon Monoxide ( DLCO)	Clinical diagnosis	Etiology: Respiratory syncytial virus, Rhinovirus Children <2 years
Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight loss	Fever	Dyspnea	Physical Examination	Lab findings	Imaging	PFT	Gold standard
Respiratory	Lung Parenchyma	Pneumonia^[32]^[33]^[34]	Acute		+	−	−	+	+	Crackles Egophony Decreased bronchial sounds, Rhonchi Rapid Breathing Intercostal retractions Nasal Flaring, Grunting Tachypnea, Tachycardia Vomiting	Leftward shift leukocytosis Blood culture in hospitalized patients Sputum culture in hospitalized patients	Consolidation, cavitation, and infiltrated interstitial in chest x−ray Anatomical changes observed in chest CT	Not specific	Infiltration observed in chest x−ray	Community−acquired pneumonia Healthcare−associated pneumonia
Respiratory	Lung Parenchyma	Tuberculosis (TB)^[35]	Chronic^[36]	Weeks to months	+	+	+	+	+	Pleural effusion Crackles Whispered pectoriloquy Decreased fremitus Rhonchi	Sputum AFB stain may be +. Mycobacterium Tuberculosis culture may be + Molecular testing may be helpful	Reactivation of TB is observed as infiltration in the upper lobe in chest x−ray	Decreased FEV1 Reduced FVC	Isolation of Mycobacterium tuberculosis	Etiology: Mycobacterium tuberculosis
Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight loss	Fever	Dyspnea	Physical Examination	Lab findings	Imaging	PFT	Gold standard
Cardiac		Cardiac Failure^[37]^[38]	Acute	Hours	−	−	+	−	+	Crackles Increased respiratory rate, retraction Wheezing, Grunting, Nasal flaring JVD Displacement of apex beat Gallop rhythm, Murmur may present. Hepatomegaly, Ascites	The following investigations may be helpful: Arterial blood gas BUN Serum creatinin Serum troponin Electrolytes Lactic acid Complete blood count	Cardiomegaly, interstitial edema, alveolar edema, Pleural effusion and blood redistribution in lower lobes in chest x−ray	Not specific	Clinical diagnosis Tests are supportive	12−lead ECG Plasma BNP and NT−proBNP Echocardiography
Cardiac		Congenital Heart Disease	Acute or Chronic	Variable	+	+	−	−	+	Crackles Hoarseness	Not specific	Electrocardiogram may be helpful Enlargement of left atrium and appendage in chest radiograph	FVC reduced	Resting transthoracic echocardiography	Stress testing Cardiac catheterization
Organ system		Diseases	Clinical manifestations								Diagnosis				Other features
			Symptoms							Physical exam	Diagnosis
			Onset	Duration	Productive cough	Hemoptysis	Weight loss	Fever	Dyspnea	Physical Examination	Lab findings	Imaging	PFT	Gold standard
Gastrointestinal		Gastroesophageal reflux^[39]^[40]	Chronic	Variable	+	−	+	−	+	Wheezing Hoarseness Regurgitation, Vomiting Back Arching, crying *Apnea Epigastric pain	Not specific	Upper endoscopy may be helpful Barium esophagram may be helpful	Normal function	PH testing	−−

Epidemiology and Demographics

A cough is one of the most common presenting symptoms of children in the outpatient department.
Ninety percent of acute coughs in children are resolved within three weeks. The prevalence of chronic cough in children is approximately 5% to 10% in the USA according to the American Academy of Pediatrics.

Age

Cough is more commonly observed among children under 5 years of age.^[41]

Gender

Boys are more commonly affected with cough than girls.^[42]

Race

There are racial predispositions for certain causes of cough in children. Asthma is predominant in Blacks and American Indians or Alaska natives while Cystic fibrosis, Wegener's granulomatosis more frequently affect Caucasians according to the American Lung Association.

Risk Factors

Common risk factors in the development of a cough in children are:^[43]^[44]
- Preterm birth and delivery by caesarian section.
- Respiratory Distress Syndrome.
- Congenital Heart Disease.
- Age less than 1 year.
- Maternal Influenza vaccination.
- Malnutrition.
- Secondary exposure to tobacco smoke.
- Air pollutants, Mold, Inadequate ventilation.
- Immunodeficiencies.
- Daycare attendance.
- History of Atopy.
- Household pets.
- Low socioeconomic status.

Natural History, Complications and Prognosis

The majority of patients with acute cough have recovery within three weeks in 90% of cases. Some cases are progressed to subacute and chronic phases. Chronic cough lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.^[45]
Early clinical features include frequent episodes of coughing, runny nose, sneezing, low grade fever, sore throat, night sweats, arching back, irritability, failure to thrive, fussiness, and a choking sensation(foreign body impaction).^[46]
If left untreated, acute cough can cause following the complications in children:^[4]^[45]
- Otitis Media
- Rash
- Vomiting
- Diarrhea
- Bronchitis
- Pneumonia
Chronic cough can progress to^[47]-
- Inability to sleep
- Bronchospasm
- Dizziness/ Syncope
- Pneumothorax
- Pneumomediastinum
Rib fracture

Prognosis is generally excellent and efficiently treatable in most of the etiology of cough in children.

Diagnosis

Diagnostic Criteria

Diagnosis of causes of a cough is made after a detailed history, presenting complaints and physical examination and laboratory findings in some cases. Cough can be classified according to:^[48]
- Duration.
- Nature or quality of cough.
- Etiology.
- Anatomic location.
- Grade.

A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with vomiting, food intake, posture, presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.

The following signs are alarming which need further emergent evaluation by the physician:

Symptoms

Cough may be associated with the following depending upon the cause:

Breathlessness and episodes of coughing
Sneezing
Fever
Sore Throat
Night Sweats
Arching Back
Irritability
Failure to thrive
Fussiness
Choking sensation(Foreign body impaction)
Chills and Rigor
Wheezing
Headache, myalgia, fatigue

Physical Examination

Patients with cough are usually restless, irritable, fussy. Children with severe respiratory distress usually are toxic and cyanotic in appearance. Presence of grunting, nasal flaring, intercostal or subcostal retraction or accessory muscle usage needs prompt evaluation.^[46]^[48]
Physical examination may be remarkable for:

Vital signs: Documentation according to patient's age

- Growth charts and developmental milestones: weight, height, length, occipitofrontal circumference
General Appearance: Level of consciousness, Cyanosis, Distressed or ill-appearing, hydration and nutritional status.
Skin: Turgor, color, texture, rashes or any other abnormal findings.
Lymphatics: Lymphadenopathy, location, number and size, consistency, adherence to underlying structures.
Head: Size, shape, fontanelle, overlapping suture, scalp, hair.
Eyes: Lacrimation, redness, irritation, conjunctival injection, periorbital redness.
Ears: Position of ears along with external auditory canal, tympanic membrane visualization.
Nose: Any deviation of nasal septum, normal or hypertrophied inferior turbinate, nasal polyps and congestion, nasal discharge, tenderness over sinus point.
Mouth and throat: Look for any associated abnormality
- Lips: Color, mucosal abnormality and congenital lesions.
- Buccal mucosa: Hydration, Color, Presence of anomaly.
- Tongue and teeth and gum: Developmental anomaly, Color, papillae.
- Palate: Anomaly, arch.
- Tonsils: Color, size, any membrane, calcification and exudates.
- Posterior pharyngeal wall: Color, appearance.
- Gag reflex: Intact or not.
Neck: Thyroid, trachea position and examination, any cystic or nodular masses, presence of nuchal rigidity.
Respiratory:
- Inspection: Breathing pattern (abdominal and periodic), respiratory rate, accessory muscle usage, chest wall shape.
- Auscultation: breath sound symmetry, vesicular, bronchial, rales, rhonchi, wheezes, stridor.
- Percussion: resonance, hyper resonance and dull.
- Palpation: trachea position, tactile fremitus.
Cardiovascular: rhythm, murmur, any radiation of sound, pulse in both extremities.
Gastrointestinal: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses or rebound guarding.
Musculoskeletal: Aching back, scoliosis, lordosis, kyphoscoliosis, swelling and tenderness in any muscles, joint, clubbing, edema, deformity of extremities, gait and posture, any sign for hip dysplasia.
CNS: Primitive reflex, superficial and deep tendon reflex, strength and tone of muscles, cranial nerve examination.
Genitourinary: Presence of external genitalia deformity , hydrocele, cryptorchidism or hernia.

Laboratory Findings

There are no specific laboratory findings associated with cough. Laboratory tests are done to differentiate the causes of cough in children^[47].
Complete Blood Count
Arterial blood gas analysis
Culture of nasopharyngeal swab and broncho alveolar lavage
Gross and microscopic analysis and culture of sputum
AFB testing and tuberculosis screening
Allergy test
Serum Immunoglobulins, autoantibodies
Sweat test
Exhaled nitric oxide test
Esophageal pH
Serology for Pertusis, CMV, Chlamydia, HIV.

Electrocardiogram

An ECG may not be helpful in the diagnosis of congenital heart disease, myocarditis, valvular heart disease, in children.

X-ray

Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: Pneumonia, Croup, Bronchitis, Epiglottitis, Foreign body impaction etc. X-ray of paranasal sinuses helps in diagnosis of sinusitis, deviated nasal septum.

Echocardiography or Ultrasound

Echocardiography/ultrasound may be helpful in the diagnosis of causes of cough in children. Echocardiographic findings aide in the diagnosis of congenital heart disease, whereas USG findings can help in evaluating complications like peritonsillar abscess, retropharyngeal abscess promptly.

CT scan

The High resolution CT is used for diagnosing causes of chronic cough in children such as bronchiectasis. Sometimes it helps in identifying congenital heart and lung anomalies.

MRI

A Chest MRI may be helpful in the diagnosis of the dynamic function of airways disease.^[49]. MRI can provide detailed findings of perfusion, ventilation mechanism of lungs and diaphragm. It can show oxygen enhancement, congenital anomalies too.

Other Imaging Findings

Other imaging techniques are used to evaluate causes of cough in children.

Flexible Bronchoscopy
Barium esophagram.
Angiography

Other Diagnostic Studies

Other investigations done to rule out differential diagnosis of cough in children are:

Spirometry for evaluating pulmonary function test.
Bronchodilator provocation test.
Ciliary function test.
Genetic analysis for CFTR mutation, Primary ciliary dyskinesia etc.
Video fluoroscopic or endoscopic swallow evaluation.
Environmental assessment.

Treatment

Medical Therapy

The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in the following sequences:^[1]^[50]^[51]^[52]
Identification of etiology of cough and emergently manage the emergency condition such as foreign body impaction, severe respiratory distress, apnea with maintenance of airways, breathing, circulation.
General measures with adequate hydration, nasal airway clearance with normal saline, reducing fever with antipyretics are done to give comfort to the child.
Medical management:
- Antihistamine, antitussive medications and nasal decongestant are provided for alleviating symptoms of acute cough. Allergic conditions are treated with steroids.
- Bronchodilators (Ipratropium bromide, Albuterol, Salmeterol, Salbutamol), Antibiotic (Amoxicillin/Clavulanate, Cephalosporins, Respiratory fluoroquinolones, Antiviral, Antifungal, Antiparasitic) are used according to evidence-based management of particular causes of cough in children.

Surgery

Some surgical procedures are performed for patients with Tonsillitis, adenoid hypertrophy, severe cases of laryngomalacia, tracheoesophageal fistula, congenital heart disease, complications of any disease or trauma in ear, nose, sinuses, pharynx, larynx, trachea, bronchus, lungs, and ribs.

Prevention

Effective measures for the primary prevention of cough include:
- Caregivers should be given health education on pros and cons of vaccination, alarming features of cough.
- Physical hygiene including airways of an infant or a child should be maintained to prevent complications.
- Head should be raised to prevent irritations in throat.
- Humidified air will help clearing the sputum easily.
- Adequate hydration to prevent formation of dry sputum.
- Avoidance of triggers in case of atopic patient.
- Nutritional balance should be maintained for rebooting the immunity.

References

↑ ^1.0 ^1.1 Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S (March 2015). "Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA)". Int J Pediatr Adolesc Med. 2 (1): 38–43. doi:10.1016/j.ijpam.2015.03.001. PMID 30805435.
↑ Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J (April 2009). "Semantics and types of cough". Pulm Pharmacol Ther. 22 (2): 139–42. doi:10.1016/j.pupt.2008.12.008. PMID 19136069.
↑ Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (June 2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMID 22958367.
↑ ^4.0 ^4.1 "Acute cough in children".
↑ Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC (May 2006). "Causes and clinical features of subacute cough". Chest. 129 (5): 1142–7. doi:10.1378/chest.129.5.1142. PMID 16685003.
↑ Bergamini M, Kantar A, Cutrera R, Interest Group I (2017). "Analysis of the Literature on Chronic Cough in Children". Open Respir Med J. 11: 1–9. doi:10.2174/1874306401711010001. PMID 28553418. Vancouver style error: initials (help)
↑ Abdallah C (July 2012). "Acute epiglottitis: Trends, diagnosis and management". Saudi J Anaesth. 6 (3): 279–81. doi:10.4103/1658-354X.101222. PMC 3498669. PMID 23162404.
↑ "Epiglottitis, Acute Laryngitis, and Croup".
↑ Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
↑ Bellamy EA, Johnston ID, Wilson AG (1987). "The chest radiograph in whooping cough". Clin Radiol. 38 (1): 39–43. PMID 3816065.
↑ "Pertussis | Whooping Cough | Clinical | Information | CDC".
↑ Eccles R (2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889.
↑ Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
↑ Bartlett A, Bola S, Williams R (2015). "Acute tonsillitis and its complications: an overview". J R Nav Med Serv. 101 (1): 69–73. PMID 26292396.
↑ Di Muzio F, Barucco M, Guerriero F (December 2016). "Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine". Eur Rev Med Pharmacol Sci. 20 (23): 4950–4954. PMID 27981538.
↑ Kumar V (February 2017). "Influenza in Children". Indian J Pediatr. 84 (2): 139–143. doi:10.1007/s12098-016-2232-x. PMID 27641976.
↑ Kondrich J, Rosenthal M (June 2017). "Influenza in children". Curr Opin Pediatr. 29 (3): 297–302. doi:10.1097/MOP.0000000000000495. PMID 28346272.
↑ Badr DT, Gaffin JM, Phipatanakul W (September 2016). "Pediatric Rhinosinusitis". Curr Treat Options Allergy. 3 (3): 268–281. doi:10.1007/s40521-016-0096-y. PMC 5193235. PMID 28042527.
↑ Shahid SK (2012). "Rhinosinusitis in children". ISRN Otolaryngol. 2012: 851831. doi:10.5402/2012/851831. PMC 3671714. PMID 23762621.
↑ Gelfand EW (May 2009). "Pediatric asthma: a different disease". Proc Am Thorac Soc. 6 (3): 278–82. doi:10.1513/pats.200808-090RM. PMC 2677403. PMID 19387030.
↑ van Aalderen WM (2012). "Childhood asthma: diagnosis and treatment". Scientifica (Cairo). 2012: 674204. doi:10.6064/2012/674204. PMC 3820621. PMID 24278725.
↑ Zhang XB, Wu X, Nong GM (March 2020). "Update on protracted bacterial bronchitis in children". Ital J Pediatr. 46 (1): 38. doi:10.1186/s13052-020-0802-z. PMC 7106696 Check |pmc= value (help). PMID 32228653 Check |pmid= value (help).
↑ "www.thoracic.org" (PDF).
↑ Pizzutto SJ, Hare KM, Upham JW (2017). "Bronchiectasis in Children: Current Concepts in Immunology and Microbiology". Front Pediatr. 5: 123. doi:10.3389/fped.2017.00123. PMC 5447051. PMID 28611970.
↑ Redding GJ (February 2009). "Bronchiectasis in children". Pediatr Clin North Am. 56 (1): 157–71, xi. doi:10.1016/j.pcl.2008.10.014. PMID 19135586.
↑ Bouyahia O, Essadem L, Matoussi N, Gharsallah L, Fitouri Z, Mrad Mazigh S, Boukthir S, Bellagah I, Ben Becher S, Sammoud El Gharbi A (November 2008). "Etiology and outcome of bronchiectasis in children: a study of 41 patients". Tunis Med. 86 (11): 996–9. PMID 19213492.
↑ Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC (February 2008). "Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment". J Bras Pneumol. 34 (2): 74–82. doi:10.1590/s1806-37132008000200003. PMID 18345450.
↑ Aslan N, Yıldızdaş D, Özden Ö, Yöntem A, Horoz ÖÖ, Kılıç S (2019). "Evaluation of foreign body aspiration cases in our pediatric intensive care unit: Single-center experience". Turk Pediatri Ars. 54 (1): 44–48. doi:10.14744/TurkPediatriArs.2019.60251. PMC 6559979 Check |pmc= value (help). PMID 31217709.
↑ Ayed AK, Jafar AM, Owayed A (August 2003). "Foreign body aspiration in children: diagnosis and treatment". Pediatr Surg Int. 19 (6): 485–8. doi:10.1007/s00383-003-0965-x. PMID 12736750.
↑ Friedman JN, Rieder MJ, Walton JM (November 2014). "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age". Paediatr Child Health. 19 (9): 485–98. doi:10.1093/pch/19.9.485. PMC 4235450. PMID 25414585.
↑ Smith DK, Seales S, Budzik C (January 2017). "Respiratory Syncytial Virus Bronchiolitis in Children". Am Fam Physician. 95 (2): 94–99. PMID 28084708.
↑ Katz SE, Williams DJ (March 2018). "Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research". Infect Dis Clin North Am. 32 (1): 47–63. doi:10.1016/j.idc.2017.11.002. PMC 5801082. PMID 29269189.
↑ Rodrigues C, Groves H (March 2018). "Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis". J Clin Microbiol. 56 (3). doi:10.1128/JCM.01318-17. PMC 5824044. PMID 29237789. Vancouver style error: initials (help)
↑ Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, Bhat N, Murdoch DR, Crawley J, Levine OS, O'Brien KL, Feikin DR (April 2012). "The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study". Clin Infect Dis. 54 Suppl 2: S109–16. doi:10.1093/cid/cir1065. PMC 3297550. PMID 22403224.
↑ Thomas TA (August 2017). "Tuberculosis in Children". Pediatr Clin North Am. 64 (4): 893–909. doi:10.1016/j.pcl.2017.03.010. PMC 5555046. PMID 28734517.
↑ Marais BJ, Schaaf HS (July 2014). "Tuberculosis in children". Cold Spring Harb Perspect Med. 4 (9): a017855. doi:10.1101/cshperspect.a017855. PMC 4143109. PMID 25037105.
↑ "Cough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf".
↑ Jayaprasad N (2016). "Heart Failure in Children". Heart Views. 17 (3): 92–99. doi:10.4103/1995-705X.192556. PMC 5105230. PMID 27867456.
↑ Juchet A, Brémont F, Dutau G, Olives JP (August 2001). "[Chronic cough and gastroesophageal reflux in children]". Arch Pediatr (in French). 8 Suppl 3: 629–634. doi:10.1016/s0929-693x(01)80018-x. PMID 11683086.
↑ Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, Withers GD, Patrick MK, Lewindon PJ (February 2006). "Cough and reflux esophagitis in children: their co-existence and airway cellularity". BMC Pediatr. 6: 4. doi:10.1186/1471-2431-6-4. PMC 1409774. PMID 16504152.
↑ Chang AB, Glomb WB (January 2006). "Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 260S–283S. doi:10.1378/chest.129.1_suppl.260S. PMID 16428719.
↑ "Prevalence of cough throughout childhood: A cohort study".
↑ Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash U, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM (January 2006). "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 1S–23S. doi:10.1378/chest.129.1_suppl.1S. PMC 3345522. PMID 16428686. Vancouver style error: initials (help)
↑ Hope-Simpson RE, Miller DL (November 1973). "The definition of acute respiratory illnesses in general practice". Postgrad Med J. 49 (577): 763–70. doi:10.1136/pgmj.49.577.763. PMC 2495832. PMID 4806394.
↑ ^45.0 ^45.1 Hay AD, Wilson AD (May 2002). "The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review". Br J Gen Pract. 52 (478): 401–9. PMC 1314298. PMID 12014540.
↑ ^46.0 ^46.1 Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM (April 2006). "Cough in children: definitions and clinical evaluation". Med J Aust. 184 (8): 398–403. doi:10.5694/j.1326-5377.2006.tb00290.x. PMID 16618239.
↑ ^47.0 ^47.1 "Cough • 2: Chronic cough in children | Thorax".
↑ ^48.0 ^48.1 Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE (December 1993). "Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry". Int J Epidemiol. 22 (6): 1166–73. doi:10.1093/ije/22.6.1166. PMID 8144301.
↑ Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH (December 2015). "Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging". Pediatr Radiol. 45 (13): 1901–15. doi:10.1007/s00247-015-3420-y. PMC 4666905. PMID 26342643.
↑ Goldman RD (November 2011). "Treating cough and cold: Guidance for caregivers of children and youth". Paediatr Child Health. 16 (9): 564–9. doi:10.1093/pch/16.9.564. PMC 3223897. PMID 23115499.
↑ "Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST".
↑ Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ (2019). "Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough". Glob Pediatr Health. 6: 2333794X19831296. doi:10.1177/2333794X19831296. PMC 6390215. PMID 30828592.

[pmid30805435-1] 1.0 ^1.1 Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S (March 2015). "Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA)". Int J Pediatr Adolesc Med. 2 (1): 38–43. doi:10.1016/j.ijpam.2015.03.001. PMID 30805435.

[pmid19136069-2] Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J (April 2009). "Semantics and types of cough". Pulm Pharmacol Ther. 22 (2): 139–42. doi:10.1016/j.pupt.2008.12.008. PMID 19136069.

[pmid22958367-3] Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (June 2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMID 22958367.

[urlAcute_cough_in_children-4] 4.0 ^4.1 "Acute cough in children".

[pmid16685003-5] Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC (May 2006). "Causes and clinical features of subacute cough". Chest. 129 (5): 1142–7. doi:10.1378/chest.129.5.1142. PMID 16685003.

[pmid28553418-6] Bergamini M, Kantar A, Cutrera R, Interest Group I (2017). "Analysis of the Literature on Chronic Cough in Children". Open Respir Med J. 11: 1–9. doi:10.2174/1874306401711010001. PMID 28553418. Vancouver style error: initials (help)

[pmid23162404-7] Abdallah C (July 2012). "Acute epiglottitis: Trends, diagnosis and management". Saudi J Anaesth. 6 (3): 279–81. doi:10.4103/1658-354X.101222. PMC 3498669. PMID 23162404.

[urlEpiglottitis,_Acute_Laryngitis,_and_Croup-8] "Epiglottitis, Acute Laryngitis, and Croup".

[Cherry2008-9] Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.

[pmid3816065-10] Bellamy EA, Johnston ID, Wilson AG (1987). "The chest radiograph in whooping cough". Clin Radiol. 38 (1): 39–43. PMID 3816065.

[urlPertussis_|_Whooping_Cough_|_Clinical_|_Information_|_CDC-11] "Pertussis | Whooping Cough | Clinical | Information | CDC".

[pmid16253889-12] Eccles R (2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889.

[pmid25587367-13] Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.

[pmid26292396-14] Bartlett A, Bola S, Williams R (2015). "Acute tonsillitis and its complications: an overview". J R Nav Med Serv. 101 (1): 69–73. PMID 26292396.

[pmid27981538-15] Di Muzio F, Barucco M, Guerriero F (December 2016). "Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine". Eur Rev Med Pharmacol Sci. 20 (23): 4950–4954. PMID 27981538.

[pmid27641976-16] Kumar V (February 2017). "Influenza in Children". Indian J Pediatr. 84 (2): 139–143. doi:10.1007/s12098-016-2232-x. PMID 27641976.

[pmid28346272-17] Kondrich J, Rosenthal M (June 2017). "Influenza in children". Curr Opin Pediatr. 29 (3): 297–302. doi:10.1097/MOP.0000000000000495. PMID 28346272.

[pmid28042527-18] Badr DT, Gaffin JM, Phipatanakul W (September 2016). "Pediatric Rhinosinusitis". Curr Treat Options Allergy. 3 (3): 268–281. doi:10.1007/s40521-016-0096-y. PMC 5193235. PMID 28042527.

[pmid23762621-19] Shahid SK (2012). "Rhinosinusitis in children". ISRN Otolaryngol. 2012: 851831. doi:10.5402/2012/851831. PMC 3671714. PMID 23762621.

[pmid19387030-20] Gelfand EW (May 2009). "Pediatric asthma: a different disease". Proc Am Thorac Soc. 6 (3): 278–82. doi:10.1513/pats.200808-090RM. PMC 2677403. PMID 19387030.

[pmid24278725-21] van Aalderen WM (2012). "Childhood asthma: diagnosis and treatment". Scientifica (Cairo). 2012: 674204. doi:10.6064/2012/674204. PMC 3820621. PMID 24278725.

[pmid32228653-22] Zhang XB, Wu X, Nong GM (March 2020). "Update on protracted bacterial bronchitis in children". Ital J Pediatr. 46 (1): 38. doi:10.1186/s13052-020-0802-z. PMC 7106696 Check |pmc= value (help). PMID 32228653 Check |pmid= value (help).

[urlwww.thoracic.org-23] "www.thoracic.org" (PDF).

[pmid28611970-24] Pizzutto SJ, Hare KM, Upham JW (2017). "Bronchiectasis in Children: Current Concepts in Immunology and Microbiology". Front Pediatr. 5: 123. doi:10.3389/fped.2017.00123. PMC 5447051. PMID 28611970.

[pmid19135586-25] Redding GJ (February 2009). "Bronchiectasis in children". Pediatr Clin North Am. 56 (1): 157–71, xi. doi:10.1016/j.pcl.2008.10.014. PMID 19135586.

[pmid19213492-26] Bouyahia O, Essadem L, Matoussi N, Gharsallah L, Fitouri Z, Mrad Mazigh S, Boukthir S, Bellagah I, Ben Becher S, Sammoud El Gharbi A (November 2008). "Etiology and outcome of bronchiectasis in children: a study of 41 patients". Tunis Med. 86 (11): 996–9. PMID 19213492.

[pmid18345450-27] Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC (February 2008). "Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment". J Bras Pneumol. 34 (2): 74–82. doi:10.1590/s1806-37132008000200003. PMID 18345450.

[pmid31217709-28] Aslan N, Yıldızdaş D, Özden Ö, Yöntem A, Horoz ÖÖ, Kılıç S (2019). "Evaluation of foreign body aspiration cases in our pediatric intensive care unit: Single-center experience". Turk Pediatri Ars. 54 (1): 44–48. doi:10.14744/TurkPediatriArs.2019.60251. PMC 6559979 Check |pmc= value (help). PMID 31217709.

[pmid12736750-29] Ayed AK, Jafar AM, Owayed A (August 2003). "Foreign body aspiration in children: diagnosis and treatment". Pediatr Surg Int. 19 (6): 485–8. doi:10.1007/s00383-003-0965-x. PMID 12736750.

[pmid25414585-30] Friedman JN, Rieder MJ, Walton JM (November 2014). "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age". Paediatr Child Health. 19 (9): 485–98. doi:10.1093/pch/19.9.485. PMC 4235450. PMID 25414585.

[pmid28084708-31] Smith DK, Seales S, Budzik C (January 2017). "Respiratory Syncytial Virus Bronchiolitis in Children". Am Fam Physician. 95 (2): 94–99. PMID 28084708.

[pmid29269189-32] Katz SE, Williams DJ (March 2018). "Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research". Infect Dis Clin North Am. 32 (1): 47–63. doi:10.1016/j.idc.2017.11.002. PMC 5801082. PMID 29269189.

[pmid29237789-33] Rodrigues C, Groves H (March 2018). "Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis". J Clin Microbiol. 56 (3). doi:10.1128/JCM.01318-17. PMC 5824044. PMID 29237789. Vancouver style error: initials (help)

[pmid22403224-34] Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, Bhat N, Murdoch DR, Crawley J, Levine OS, O'Brien KL, Feikin DR (April 2012). "The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study". Clin Infect Dis. 54 Suppl 2: S109–16. doi:10.1093/cid/cir1065. PMC 3297550. PMID 22403224.

[pmid28734517-35] Thomas TA (August 2017). "Tuberculosis in Children". Pediatr Clin North Am. 64 (4): 893–909. doi:10.1016/j.pcl.2017.03.010. PMC 5555046. PMID 28734517.

[pmid25037105-36] Marais BJ, Schaaf HS (July 2014). "Tuberculosis in children". Cold Spring Harb Perspect Med. 4 (9): a017855. doi:10.1101/cshperspect.a017855. PMC 4143109. PMID 25037105.

[urlCough_or_difficulty_in_breathing_-_Pocket_Book_of_Hospital_Care_for_Children_-_NCBI_Bookshelf-37] "Cough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf".

[pmid27867456-38] Jayaprasad N (2016). "Heart Failure in Children". Heart Views. 17 (3): 92–99. doi:10.4103/1995-705X.192556. PMC 5105230. PMID 27867456.

[pmid11683086-39] Juchet A, Brémont F, Dutau G, Olives JP (August 2001). "[Chronic cough and gastroesophageal reflux in children]". Arch Pediatr (in French). 8 Suppl 3: 629–634. doi:10.1016/s0929-693x(01)80018-x. PMID 11683086.

[pmid16504152-40] Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, Withers GD, Patrick MK, Lewindon PJ (February 2006). "Cough and reflux esophagitis in children: their co-existence and airway cellularity". BMC Pediatr. 6: 4. doi:10.1186/1471-2431-6-4. PMC 1409774. PMID 16504152.

[pmid16428719-41] Chang AB, Glomb WB (January 2006). "Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 260S–283S. doi:10.1378/chest.129.1_suppl.260S. PMID 16428719.

[urlPrevalence_of_cough_throughout_childhood:_A_cohort_study-42] "Prevalence of cough throughout childhood: A cohort study".

[pmid16428686-43] Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash U, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM (January 2006). "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 1S–23S. doi:10.1378/chest.129.1_suppl.1S. PMC 3345522. PMID 16428686. Vancouver style error: initials (help)

[pmid4806394-44] Hope-Simpson RE, Miller DL (November 1973). "The definition of acute respiratory illnesses in general practice". Postgrad Med J. 49 (577): 763–70. doi:10.1136/pgmj.49.577.763. PMC 2495832. PMID 4806394.

[pmid12014540-45] 45.0 ^45.1 Hay AD, Wilson AD (May 2002). "The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review". Br J Gen Pract. 52 (478): 401–9. PMC 1314298. PMID 12014540.

[pmid16618239-46] 46.0 ^46.1 Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM (April 2006). "Cough in children: definitions and clinical evaluation". Med J Aust. 184 (8): 398–403. doi:10.5694/j.1326-5377.2006.tb00290.x. PMID 16618239.

[urlCough_•_2:_Chronic_cough_in_children_|_Thorax-47] 47.0 ^47.1 "Cough • 2: Chronic cough in children | Thorax".

[pmid8144301-48] 48.0 ^48.1 Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE (December 1993). "Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry". Int J Epidemiol. 22 (6): 1166–73. doi:10.1093/ije/22.6.1166. PMID 8144301.

[pmid26342643-49] Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH (December 2015). "Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging". Pediatr Radiol. 45 (13): 1901–15. doi:10.1007/s00247-015-3420-y. PMC 4666905. PMID 26342643.

[pmid23115499-50] Goldman RD (November 2011). "Treating cough and cold: Guidance for caregivers of children and youth". Paediatr Child Health. 16 (9): 564–9. doi:10.1093/pch/16.9.564. PMC 3223897. PMID 23115499.

[urlGuidelines_for_Evaluating_Chronic_Cough_in_Pediatrics_CHEST-51] "Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST".

[pmid30828592-52] Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ (2019). "Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough". Glob Pediatr Health. 6: 2333794X19831296. doi:10.1177/2333794X19831296. PMC 6390215. PMID 30828592.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{SI}}
-{{CMG}} {{AE}}
+{{CMG}} {{AE}} {{MMT}}
 {{SK}} Cough in kids
 ==Overview==
+[[Cough]] is a common complaint of the [[Pediatrics|pediatric]] population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of [[respiratory]] airways. The word [[Cough|'Cough]]' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, [[anatomical]] location, [[etiology]] and grades of coughs. Stimulation to cough [[receptors]] provokes sensations of coughing through the [[afferent]] pathway via the [[vagus nerve]], central respiratory centers in the upper [[pons]] and [[medulla]], and [[efferent]] pathways via the [[phrenic]] and [[vagus]] branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of [[physical examination]], [[laboratory]], and [[imaging]] investigations. Some of the causes are emergently managed to reduce the [[mortality]] of a child.The mainstay of therapy for cough is supportive. [[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
 ==Historical Perspective==
-*The word Cough was first derived from the middle English Coughen or old English Cohhian which was primarily composed of the middle Dutch Kochen and the high middle German Kuchen, in early 14th century.
+*The word [[cough]] was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.
 ==Classification==
-*Cough in children may be classified or defined according to the duration of presenting complaints, quality and sound,  causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
-*1 Duration of Presenting complaints: According to the duration of cough, it can be sub classified into three categories.
-**Acute: Cough persists for less than three weeks.
-**Subacute: Cough persists for three to eight weeks.
-**Chronic: Cough persists for more than eight weeks.
-*2. Quality and sounds: According to the quality and sound cough can be sub classified in to following categories-
+*[[Cough]] in children may be classified or defined according to the duration of [[Presenting symptom|presenting]] complaints, quality and sound, and causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
-**Dry or Hacking or Nonproductive.
+*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub-classified into three categories:
-**Wet or productive cough.
+**[[Acute]]: < 3 weeks.
+**[[Subacute]]: 3 to 8 weeks.
+**[[Chronic]]: > 8 weeks.
+*2. [[Nature]] or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
+**[[Dry Cough|Dry]] or Hacking or Nonproductive.
+**Wet or [[productive cough]].
 **Staccato or short repetitive cough.
-**Whooping or paroxysmal violent or spasmodic cough.
+**[[Whooping Cough|Whooping]] or paroxysmal violent or spasmodic cough.
-**Barking cough: Brassy barking or Honking barking.
+**[[Barking cough]]: Brassy barking or Honking barking.
 **Phlegmy cough.
 **Burning cough.
-*3. Causes of Cough: Based on causes cough is subdivided into following three sub groups-
+*3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
-**Normal or expected cough.
 **Specific cough.
-**Non-specific cough.
+**Nonspecific cough.
+**Expected cough or Normal cough.
-*4. Anatomic classification on causes of cough: Cough can be produced from different anatomical locations. for example-
+*4. [[Anatomic]] classification on the causes of a cough: A cough can be produced from different [[anatomical]] locations. For example:
-**Nose and Paranasal sinuses.
+**[[Nose]] and [[Paranasal sinus|Paranasal]] sinuses.
-**Pharynx.
+**[[Pharynx]].
-**Larynx.
+**[[Larynx]].
-**Trachea and Bronchi.
+**[[Trachea]] and [[Bronchi]].
-**Pulmonary parenchyma.
+**[[Pulmonary]] parenchyma.
-**Pleura.
+**[[Pleura]].
-**Mediastinum.
+**[[Mediastinum]].
-**Heart and blood vessels.
+**[[Heart]] and [[Blood vessel|blood vessels]].
-**External ear and Tympanic membrane.
+**[[External ear]] and [[Tympanic membrane]].
-**Esophagus.
+**[[Esophagus]].
-*5. Grades of cough: Cough can be graded into four main sub categories-<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
+*5. Grades of [[cough]]: Cough can be graded into four main sub categories:<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
 **Eutussia or Normal.
 **Hypertussia or Sensitized.
@@ Line 51: / Line 53: @@
 **Atussia or Absent.
-Cough in children can also be classified under infectious (Bacterial, Viral, fungal, Parasitic) or non-infectous categories broadly.
+[[Cough]] in children can also be classified under [[infectious]] ([[Bacterial]], [[Viral|Viral,]] [[fungal]], [[Parasitic]]) or non-infectious categories broadly.
 ==Pathophysiology==
-*Cough is natural innate primitive reflex that helps in mucocilliary clearance of foreign particles and secretions from respiratory tracts. It is also a defensive mechanism protecting respiratory airways from aspiration of pathogens, particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the cough reflex.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
+*A [[cough]] is a natural [[Innate immune response|innate]] [[Primitive reflexes|primitive reflex]] that helps in mucocilliary clearance of foreign particles and secretions from [[Respiratory tract|respiratory t]]<nowiki/>racts. It is also a defense mechanism protecting the [[Respiratory|respiratory airway]]<nowiki/>s from [[aspiration]] of [[pathogens]], particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the [[Cough reflex|cough refle]]<nowiki/>x.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
 {{Family tree/start}}
-{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (Rapidly adapting receptors, slowly adapting receptors or C-fibers) in [[Respiratory airways]]}}
+{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in [[Respiratory airways]]}}
 {{Family tree | | | | |:| | | | | }}
 {{Family tree | | | | B01 | | | |B01=[[Afferent]] pathways: Sensory nerve fibers  via [[Vagus Nerve]] from [[ciliated columnar epithelium]] of upper [[airways]], [[cardiac]] and [[esophageal]] branches from [[diaphragm]] send impulse to central [[cough center]]}}
@@ Line 64: / Line 67: @@
 {{Family tree | | | | B01 | | | |B01=[[Efferent]] pathways: The [[nucleus retroambigualis]] sends impulse via [[phrenic]] and [[spinal motor nerves]] to [[diaphragm]] and abdominal and [[respiratory muscles]], the [[nucleus ambiguous]] sends impulse to [[larynx]] by [[laryngeal]] branches of [[vagus nerve]] }}
 {{Family tree/end}}
-*On gross pathology, Bloody, Serous , Mucoid, Rusty, Pink frothy, and Purulent are characteristic findings of sputum produced by coughing.
-*On microscopic histopathological analysis, Pathogens, RBCs, Leukocytes, epithelial celss are characteristic findings of Sputum produced by coughing.
+*On [[gross pathology]], [[Bloody sputum|bloody]], serous , mucoid, rusty, pink frothy, and [[purulent]] are characteristic findings of [[sputum]] produced by [[coughing]].
+*On [[microscopic]] [[histopathological]] [[analysis]], [[pathogens]], [[red blood cell|RBC]]<nowiki/>s, [[leukocytes]], [[epithelial cells]] are characteristic findings of [[sputum]] produced by [[coughing]].
 ==Causes==
@@ Line 75: / Line 79: @@
 {{familytree/end}}
-According to quality and sound of cough in children, the causes can be classified according to following chart.
+According to quality and sound of cough in children, the causes can be classified according to the following chart:
 {{familytree/start |summary=PE diagnosis Algorithm.}}
-{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smokes), [[Post infectious cough]]. }}
+{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smoke), [[Post infectious cough]]. }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Wet or [[productive]] cough |B02=[[Cystic fibrosis]], [[Bronchiectasis]], [[Bronchiolitis]], [[Tuberculosis]], [[Rhinitis]], [[Postnasal drip]], [[Pneumonia]], [[Emphysema]], [[Acute bronchitis]], [[Asthma]] }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01=Causes of Cough based on quality and sound |C02=[[Staccato]] or short repetitive cough |C03=[[Chlamydia]] pneumonia }}
+{{familytree | | | | | | C01 |-|+|-| C02 |-| C03 | | | |C01=Causes of Cough based on Nature or quality and sound |C02=[[Staccato]] or short repetitive cough |C03=[[Chlamydia]] pneumonia }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |)|-| D01 |-| D02 | | | |D01=[[Whooping]] or [[paroxysmal]] violent or spasmodic cough |D02=[[Pertussis]] }}
@@ Line 88: / Line 92: @@
 {{familytree | | | | | | | | | |)|-| E01 |-| E02 | | | |E01=[[Barking]] cough |E02=•[[Brassy]] barking: [[Croup]], [[Tracheomalacia]], [[Laryngitis]], [[Tracheitis]] <br>•[[Honking]] barking: [[Psychogenic]] cough , [[Tourette syndrome]] (habit cough) }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | |)|-| F01 |-| F02 | | | |F01=Phlegmy cough |F02=[[Viral]] infection }}
+{{familytree | | | | | | | | | |)|-| F01 |-| F02 | | | |F01=[[Stridor]] |F02=[[Viral]] [[Croup]], [[Epiglottis]], [[Bacterial tracheitis]], [[Retropharyngeal]] and [[peritonsilar]] [[abscess]] }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |`|-| G01 |-| G02 | | | |G01=Burning cough |G02=[[Bacterial Bronchitis]], Irritants }}
@@ Line 94: / Line 98: @@
 {{familytree/end}}
-Based on anatomical location the causes of cough in children can be demonstrated into following chart-
+Based on anatomical location the causes of cough in children can be demonstrated in the following chart:
 {{familytree/start |summary=PE diagnosis Algorithm.}}
-{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Nose and Paranasal sinuses |A02=[[Rhinitis]], [[Foreign Body]], [[Sinusitis]], [[Nasal polyp]], ppHypertrophied inferior turbinate]] }}
+{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Nose and Paranasal sinuses |A02=[[Rhinitis]], [[Foreign Body]], [[Sinusitis]], [[Nasal polyp]]<nowiki>, ppHypertrophied inferior turbinate]]</nowiki> }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Pharynx |B02=[[Pharyngitis]], [[Foreign Body]], [[Irritants]] }}
@@ Line 111: / Line 115: @@
 {{familytree | | | | | | | | | |)|-| G01 |-| G02 | | | |G01=Mediastinum |G02= [[Mediastinitis]], [[Mediastinal Tuberculosis]], [[Thymoma]], [[Thymic hyperplasia]], [[Thymic carcinoma]], [[Neuroblastoma]], [[Ganglioneuroma]], [[Non Hodgkin lymphoma]], [[Sarcoma]], [[Mature teratoma]], [[Endodermal sinus tumor]], [[Hemangioma]], [[Wilms tumor]], [[Lymphangioma]] }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
-{{familytree | | | | | | | | | |)|-| H01 |-| H02 | | | |H01=Heart and blood vessels |H02=[[Congenital heart disease]], [[Valvular heart disease]], [[Heart failure]], [[Myocarditis]], [[Cardiomyopathies]], [[Wegener granulomatosis]], [[Vasculitis]], [[Arteriovenous malformation]] }}
+{{familytree | | | | | | | | | |)|-| H01 |-| H02 | | | |H01=Heart and blood vessels |H02=[[Congenital heart disease]], [[Myocarditis]], [[Heart failure]], [[Cardiomyopathies]], [[Wegener granulomatosis]], [[Valvular heart disease]], [[Vasculitis]], [[Arteriovenous malformation]] }}
 {{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
 {{familytree | | | | | | | | | |)|-| I01 |-| I02 | | | |I01=External ear and Tympanic membrane |I02= [[Otitis media]] and externa, [[Impaction of foreign body]], [[wax]], [[Myringitis]] }}
@@ Line 121: / Line 125: @@
 ==Differentiating Cough from other Diseases==
-'''For the differential diagnosis of productive cough, click [[Productive cough|here]].'''<br>
-'''For the differential diagnosis of acute cough, click [[Acute cough|here]].'''<br>
-'''For the differential diagnosis of chronic cough, click [[Chronic cough|here]].'''<br>
-'''For the differential diagnosis of cough and hemoptysis, click [[Cough and hemoptysis|here]].'''<br>
-'''For the differential diagnosis of cough and weight loss, click [[Cough and weight loss|here]].'''<br>
-'''For the differential diagnosis of cough and fever, click [[Cough and weight loss|here]].'''<br>
-'''For the differential diagnosis of cough and wheeze, click [[Cough and wheeze|here]].'''<br>
-'''For the differential diagnosis of cough, fever, and hemoptysis, click [[Cough, fever, and hemoptysis|here]].'''<br>
-'''For the differential diagnosis of cough, fever, and weight loss, click [[Cough, fever, and weight loss|here]].'''<br>
-'''For the differential diagnosis of cough, hemoptysis, and weight loss, click [[Cough, hemoptysis, and weight loss|here]].'''<br>
 <small><small>
@@ Line 148: / Line 142: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight lost
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ascultation
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
@@ Line 159: / Line 153: @@
 | rowspan="7" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
 | rowspan="7" style="background:#DCDCDC;" align="center" + |[[Upper respiratory tract|'''Upper airway diseases''']]
-| style="background:#DCDCDC;" align="center" + |[[Epiglottitis|'''Epiglottitis''']]<ref name="pmid11464324">{{cite journal |vauthors=Stroud RH, Friedman NR |title=An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis |journal=Am J Otolaryngol |volume=22 |issue=4 |pages=268–75 |year=2001 |pmid=11464324 |doi=10.1053/ajot.2001.24825 |url=}}</ref><ref name="pmid9857318">{{cite journal |vauthors=Solomon P, Weisbrod M, Irish JC, Gullane PJ |title=Adult epiglottitis: the Toronto Hospital experience |journal=J Otolaryngol |volume=27 |issue=6 |pages=332–6 |year=1998 |pmid=9857318 |doi= |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Epiglottitis|Epiglottitis]]'''<ref name="pmid23162404">{{cite journal |vauthors=Abdallah C |title=Acute epiglottitis: Trends, diagnosis and management |journal=Saudi J Anaesth |volume=6 |issue=3 |pages=279–81 |date=July 2012 |pmid=23162404 |pmc=3498669 |doi=10.4103/1658-354X.101222 |url=}}</ref><ref name="urlEpiglottitis, Acute Laryngitis, and Croup">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120939/ |title=Epiglottitis, Acute Laryngitis, and Croup |format= |work= |accessdate=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Abrupt or acute
 | style="background:#F5F5F5;" + |
-* 12−24 hours
+*12−24 hours
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |−
@@ Line 169: / Line 163: @@
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Stridor]]
+*Ill appearing child in Tripod posture
-* [[Hoarseness]]
+*[[Inspiratory Stridor]]
+*[[Hoarseness]] / Hot-potatoes or [[Muffled]] voice
+*[[Drooling]], [[Tachypnea]], [[Tachycardia]]
+*[[Cervical lymphadenopathy]], [[Erythematous]] [[pharynx]] and [[larynx]]
 | style="background:#F5F5F5;" + |
-* Elevated white blood count in CBC
+*Elevated white blood count in CBC
-* [[Blood culture]] may show bacterial growth
+*[[Blood culture]] may show bacterial growth
-* Epiglottal culture in intubated patients may show bacterial growth
+*Epiglottal culture in intubated patients may show bacterial growth
 | style="background:#F5F5F5;" + |
-* Enlarge [[epiglottis]] (>8 mm), loss of vallecular air space and distended [[hypopharynx]] in neck [[X-rays|X−ray]] may be helpful
+*Enlarge [[epiglottis]] (>8 mm), loss of vallecular air space and distended [[hypopharynx]] as known as 'Thumb print' sign on lateral neck [[X-rays|X−ray]] may be helpful
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* Direct visualization of [[Erythema|erythematous]] and edematous [[epiglottis]]
+*Direct visualization of [[Erythema|erythematous]] and edematous [[epiglottis]]
 | style="background:#F5F5F5;" + |
-* Tripod posture
+*Tripod posture
-* [[Drooling]]
+*[[Drooling]]
-* [[Tenderness]] of the anterior part of the neck
+*[[Tenderness]] of the anterior part of the neck
-* Etiology: ''[[Haemophilus influenzae]]''
+*Etiology: ''[[Haemophilus influenzae]]''
 |-
-| style="background:#DCDCDC;" align="center" + |[[Croup|'''Croup''']]<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Croup|Croup]]'''<ref name="Cherry2008">{{cite journal|last1=Cherry|first1=James D.|title=Croup|journal=New England Journal of Medicine|volume=358|issue=4|year=2008|pages=384–391|issn=0028-4793|doi=10.1056/NEJMcp072022}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* 3−5 days
+*3−5 days
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Stridor]]
+*[[Stridor]]
-* [[Rales|Crackles]]
+*[[Rales|Crackles]]
 | style="background:#F5F5F5;" + |
-* [[Leukopenia]]
+*[[Leukopenia]]
 | style="background:#F5F5F5;" + |
-* [[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
+*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
 | style="background:#F5F5F5;" + |
-* Decresed [[Lung volumes|tidal volume]]
+*Decreased [[Lung volumes|tidal volume]]
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis.
+*Clinical diagnosis.
-* Laboratory findings and imaging are not necessary for diagnosis
+*Laboratory findings and imaging are not necessary for diagnosis
 | style="background:#F5F5F5;" + |
-* [[Barking cough]]
+*[[Barking cough]]
-* Etiology: [[Human parainfluenza viruses|''Parainfluenza'' virus type 1]] (most common)
+*Etiology: [[Human parainfluenza viruses|''Parainfluenza'' virus type 1]] (most common)
 |-
-| style="background:#DCDCDC;" align="center" + |[[Pertussis|'''Pertussis''']]<ref name="pmid3816065">{{cite journal |vauthors=Bellamy EA, Johnston ID, Wilson AG |title=The chest radiograph in whooping cough |journal=Clin Radiol |volume=38 |issue=1 |pages=39–43 |year=1987 |pmid=3816065 |doi= |url=}}</ref><ref name="urlPertussis | Whooping Cough | Clinical | Information | CDC">{{cite web |url=https://www.cdc.gov/pertussis/clinical/index.html |title=Pertussis &#124; Whooping Cough &#124; Clinical &#124; Information &#124; CDC |format= |work= |accessdate=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Pertussis|Pertussis]]'''<ref name="pmid3816065">{{cite journal |vauthors=Bellamy EA, Johnston ID, Wilson AG |title=The chest radiograph in whooping cough |journal=Clin Radiol |volume=38 |issue=1 |pages=39–43 |year=1987 |pmid=3816065 |doi= |url=}}</ref><ref name="urlPertussis | Whooping Cough | Clinical | Information | CDC">{{cite web |url=https://www.cdc.gov/pertussis/clinical/index.html |title=Pertussis &#124; Whooping Cough &#124; Clinical &#124; Information &#124; CDC |format= |work= |accessdate=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* Two weeks
+*Two weeks
 | style="background:#F5F5F5;" align="center" + | + Whooping sound
 | style="background:#F5F5F5;" align="center" + |−
@@ Line 222: / Line 219: @@
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-*   Clear chest
+*Clear chest
 | style="background:#F5F5F5;" + |
-* [[Polymerase chain reaction|Polymerase chain reactio]]<nowiki/>n ([[Polymerase chain reaction|PCR]]) shows ''[[Bordetella pertussis]]''
+*[[Polymerase chain reaction|Polymerase chain reactio]]<nowiki/>n ([[Polymerase chain reaction|PCR]]) shows ''[[Bordetella pertussis]]''
-* Serologic testing
+*Serologic testing
 | style="background:#F5F5F5;" + |
-* [[Atelectasis]] may seen on chest imaging
+*[[Atelectasis]] may seen on chest imaging
-* [[Lymphadenopathy]]
+*[[Lymphadenopathy]]
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* Culture
+*Culture
 | style="background:#F5F5F5;" + |
-* Etiology: ''[[Bordetella pertussis]]''
+*Etiology: ''[[Bordetella pertussis]]''
-* Phases: Catarrhal, paroxysmal and convalescent
+*Phases: Catarrhal, paroxysmal and convalescent
 |-
-| style="background:#DCDCDC;" align="center" + |'''[[Laryngopharyngeal reflux disease|Laryngopharyngeal reflux]]'''<ref name="urlWhat is LPR? | American Academy of Otolaryngology-Head and Neck Surgery">{{cite web |url=http://www.entnet.org/content/what-lpr |title=What is LPR? &#124; American Academy of Otolaryngology-Head and Neck Surgery |format= |work= |accessdate=}}</ref><ref name="pmid12461340">{{cite journal |vauthors=Noordzij JP, Khidr A, Desper E, Meek RB, Reibel JF, Levine PA |title=Correlation of pH probe-measured laryngopharyngeal reflux with symptoms and signs of reflux laryngitis |journal=Laryngoscope |volume=112 |issue=12 |pages=2192–5 |year=2002 |pmid=12461340 |doi=10.1097/00005537-200212000-00013 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Common Cold Unit|Common Cold]]'''<ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |year=2005 |pmid=16253889 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
+| style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* Variable
+*3−10 days
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" + |
-* [[Hoarseness]]
+*[[Rales]]
-* [[Stridor]]
+*[[Wheeze|Wheezing]]
 | style="background:#F5F5F5;" + |
-* Decreased levels of salivary [[epidermal growth factor]] ([[EGF module-containing mucin-like hormone receptor|EGF]])
+*Bacterial culture is not indicated
-* Increased levels of [[NKTR]]
-* [[Biopsy]] may be helpful
 | style="background:#F5F5F5;" + |
-* [[X-rays|X−Ray]] may be helpful
+*[[Chest X-ray|Chest X−Ray]] in patients with signs of [[consolidation]]
-* [[Endoscopy]] examination may be helpful as well
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* 24 hour−dual sensor [[pH]] probe
+*Clinical diagnosis
 | style="background:#F5F5F5;" + |
-* Throat clearing
+*[[Conjunctival injection]]
-* [[Globus pharyngis|Globus sensation]]
+*[[Nasal congestion]]
 |-
-| style="background:#DCDCDC;" align="center" + |'''[[Common Cold Unit|Common Cold]]'''<ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |year=2005 |pmid=16253889 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Tonsilitis]]<ref name="pmid25587367">{{cite journal |vauthors=Stelter K |title=Tonsillitis and sore throat in children |journal=GMS Curr Top Otorhinolaryngol Head Neck Surg |volume=13 |issue= |pages=Doc07 |date=2014 |pmid=25587367 |pmc=4273168 |doi=10.3205/cto000110 |url=}}</ref><ref name="pmid26292396">{{cite journal |vauthors=Bartlett A, Bola S, Williams R |title=Acute tonsillitis and its complications: an overview |journal=J R Nav Med Serv |volume=101 |issue=1 |pages=69–73 |date=2015 |pmid=26292396 |doi= |url=}}</ref><ref name="pmid27981538">{{cite journal |vauthors=Di Muzio F, Barucco M, Guerriero F |title=Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine |journal=Eur Rev Med Pharmacol Sci |volume=20 |issue=23 |pages=4950–4954 |date=December 2016 |pmid=27981538 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Acute
+| style="background:#F5F5F5;" align="center" + |Acute or Acute Recurrent, Chronic
 | style="background:#F5F5F5;" + |
-* 3−10 days
+*Varies
-| style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + | +(Mucus from inflamed tissue)
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−/+
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
+| style="background:#F5F5F5;" align="center" + |Odynophagia, Tachypnea
 | style="background:#F5F5F5;" + |
-* [[Rales]]
+*[[Stridor]]
-* [[Wheeze|Wheezing]]
+*[[Hoarseness of voice]]/ [[Dysphonia]]
+*[[Cervical Lymphadenopathy]]
 | style="background:#F5F5F5;" + |
-* Bacterial culture is not indicated
+*Rapid Antigen Detecting Test
+*Throat Swab Culture
+*EBV Heterophile Antibody Test
+*Monospot Test
+*Complete Blood Count
 | style="background:#F5F5F5;" + |
-* [[Chest X-ray|Chest X−Ray]] in patients with signs of [[consolidation]]
+*[[Chest X-ray|Chest X−Ray]] shows normal finding. USG may show Peritonsillar abscess.
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis
+*Rapid Antigen Detecting Test
 | style="background:#F5F5F5;" + |
-* [[Conjunctival injection]]
+*Etiology: [[Rhinovirus]], [[Adenovirus]], [[Respiratory Syncitial Virus]], [[Influenza Virus]], [[Corona Virus]], [[Group A streptococci]]
-* [[Nasal congestion]]
 |-
-| style="background:#DCDCDC;" align="center" + |'''Seasonal [[Influenza (flu)|Influenza]]''' <ref name="pmid12376607">{{cite journal |vauthors=Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, Suh GY, Kwon OJ, Han J |title=Viral pneumonias in adults: radiologic and pathologic findings |journal=Radiographics |volume=22 Spec No |issue= |pages=S137–49 |year=2002 |pmid=12376607 |doi=10.1148/radiographics.22.suppl_1.g02oc15s137 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''Seasonal [[Influenza (flu)|Influenza]]'''<ref name="pmid27641976">{{cite journal |vauthors=Kumar V |title=Influenza in Children |journal=Indian J Pediatr |volume=84 |issue=2 |pages=139–143 |date=February 2017 |pmid=27641976 |doi=10.1007/s12098-016-2232-x |url=}}</ref><ref name="pmid28346272">{{cite journal |vauthors=Kondrich J, Rosenthal M |title=Influenza in children |journal=Curr Opin Pediatr |volume=29 |issue=3 |pages=297–302 |date=June 2017 |pmid=28346272 |doi=10.1097/MOP.0000000000000495 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
-| style="background:#F5F5F5;" align="center" + |
+| style="background:#F5F5F5;" + |
-* 5−10 days
+*Upper respiratory tract symptoms with fever peaking at three to four days, resolved by seven to ten days.
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + | +(High grade)
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Breath|Shorteness of breath]]
+*[[Fussiness]], [[Vomiting]], [[Diarrhea]], [[Myalgia]],
+*[[Focal wheezing]], [[Rales]], [[Tachypnea]], [[Tachycardia]], [[Retractions]], [[Seizures]]
 | style="background:#F5F5F5;" + |
-* [[Reverse transcription polymerase chain reaction|RT−PCR]]
+*[[Reverse transcription-polymerase chain reaction|RT−PCR]]
-* [[Antigen detection test]]
+*[[Virus culture]]
+*[[Rapid Influenza diagnostic test]]
+*[[Immunofluroscence]]-Direct or indirect Antibody testing
 | style="background:#F5F5F5;" + |
-* [[Reticular]] or reticulonodular opacities in [[Chest X-ray|chest X−Ray]]
+*[[Reticular]] or reticulonodular opacities in [[Chest X-ray|chest X−Ray]]
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis
+*Clinical diagnosis
 | style="background:#F5F5F5;" + |
-* Etiology: A or B [[Influenza virus|''Influenza'' virus]]
+*Etiology: A or B [[Influenza virus|''Influenza'' virus]]
 |-
-| style="background:#DCDCDC;" align="center" + |[[Rhinosinusitis|'''Rhinosinusitis''']]<ref name="pmid21490181">{{cite journal| author=Meltzer EO, Hamilos DL| title=Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 5 | pages= 427-43 | pmid=21490181 | doi=10.4065/mcp.2010.0392 | pmc=3084646 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21490181  }}</ref><ref name="pmid25832968">{{cite journal |vauthors=Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Ashok Kumar K, Kramper M, Orlandi RR, Palmer JN, Patel ZM, Peters A, Walsh SA, Corrigan MD |title=Clinical practice guideline (update): adult sinusitis |journal=Otolaryngol Head Neck Surg |volume=152 |issue=2 Suppl |pages=S1–S39 |year=2015 |pmid=25832968 |doi=10.1177/0194599815572097 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Sinusitis]]<ref name="pmid28042527">{{cite journal |vauthors=Badr DT, Gaffin JM, Phipatanakul W |title=Pediatric Rhinosinusitis |journal=Curr Treat Options Allergy |volume=3 |issue=3 |pages=268–281 |date=September 2016 |pmid=28042527 |pmc=5193235 |doi=10.1007/s40521-016-0096-y |url=}}</ref><ref name="pmid23762621">{{cite journal |vauthors=Shahid SK |title=Rhinosinusitis in children |journal=ISRN Otolaryngol |volume=2012 |issue= |pages=851831 |date=2012 |pmid=23762621 |pmc=3671714 |doi=10.5402/2012/851831 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |[[Acute (medicine)|Acute]], [[subacute]], [[chronic]], recurrent
+| style="background:#F5F5F5;" align="center" + |[[Acute]], [[Subacute]], [[Chronic]], recurrent
 | style="background:#F5F5F5;" + |
-* [[Acute (medicine)|Acute]]: Less than 4 weeks
+*[[Acute]]: < four weeks
-* [[Subacute]]: 4−12 weeks
+*[[Subacute]]: four−twelve weeks
-* [[Chronic (medical)|Chronic]]: More than 12 weeks
+*[[Chronic]]: > twelve weeks
-* Recurrent: 4 or more episodes or acute rhinosinusitis per year
+*Recurrent: > four episodes / acute episode of rhinosinusitis yearly.
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* Clear chest
+*Restlessness, Nasal Congestion, Post Nasal Drip, Facial Pain, Rhinorrhea
 | style="background:#F5F5F5;" + |
-* In complicated acute [[Rhinosinusitis|bacterial rhinosinusitis]], endoscopic cultures or [[sinus]] aspirate is indicated
+*In complicated acute [[Rhinosinusitis|bacterial rhinosinusitis]], endoscopic cultures or [[sinus]] aspirate is indicated
-* Nasal culture may also be helpful
+*Nasal culture may also be helpful
 | style="background:#F5F5F5;" + |
-* Air−fluid level, mucosal [[edema]] and bony erosion of sinus on [[Computed tomography|CT]]
+*Air−fluid level, mucosal [[edema]] and bony erosion of sinus on [[Computed tomography|CT]]
-* [[Magnetic resonance imaging|MRI]] for distinguish the [[etiology]]
+*[[Magnetic resonance imaging|MRI]] for distinguish the [[etiology]]
 | style="background:#F5F5F5;" + |
-* Normal function
+*Normal function
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis: [[Nasal congestion]], [[obstruction]], and purulent [[rhinorrhea]]
+*Clinical diagnosis: [[Nasal congestion]] and [[Post Nasal drip ]] , [[obstruction]], and purulent [[rhinorrhea]]
 | style="background:#F5F5F5;" + |
-* [[Erythema]] in [[Periorbital edema|periorbital]] area
+_
 |-
 ! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 351: / Line 352: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight lost
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ascultation
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
@@ Line 360: / Line 361: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
 |-
-| rowspan="8" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
+| rowspan="5" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
-| rowspan="8" style="background:#DCDCDC;" align="center" + |[[Lower respiratory tract|'''Lower airway''']]
+| rowspan="5" style="background:#DCDCDC;" align="center" + |[[Lower respiratory tract|'''Lower airway''']]
-| style="background:#DCDCDC;" align="center" + |[[Asthma|'''Asthma''']]<ref name="pmid19626179">{{cite journal| author=Ukena D, Fishman L, Niebling WB| title=Bronchial asthma: diagnosis and long-term treatment in adults. | journal=Dtsch Arztebl Int | year= 2008 | volume= 105 | issue= 21 | pages= 385-94 | pmid=19626179 | doi=10.3238/arztebl.2008.0385 | pmc=2696883 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19626179  }}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Asthma|Asthma]]'''<ref name="pmid19387030">{{cite journal |vauthors=Gelfand EW |title=Pediatric asthma: a different disease |journal=Proc Am Thorac Soc |volume=6 |issue=3 |pages=278–82 |date=May 2009 |pmid=19387030 |pmc=2677403 |doi=10.1513/pats.200808-090RM |url=}}</ref><ref name="pmid24278725">{{cite journal |vauthors=van Aalderen WM |title=Childhood asthma: diagnosis and treatment |journal=Scientifica (Cairo) |volume=2012 |issue= |pages=674204 |date=2012 |pmid=24278725 |pmc=3820621 |doi=10.6064/2012/674204 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Chronic
 | style="background:#F5F5F5;" + |
-* Years
+*Years
 | style="background:#F5F5F5;" align="center" + | +  Clear [[Mucoid plaque|mucoid]] or yellow [[sputum]]
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]] (expiratory)
-* [[Rales]]
-* [[Rhonchi]]
-| style="background:#F5F5F5;" + |
-* [[Eosinophilia]]
-* Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]] may be helpful
-| style="background:#F5F5F5;" + |
-* Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
-* [[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  X−Ray]]
-| style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
-* After physical active [[FEV1]] decreases by >15%
-* After inhaled [[corticosteroid]] (ICS)[[FEV1]] increased by >15%
-| style="background:#F5F5F5;" + |
-* Airflow limitation on [[spirometry]]
-| style="background:#F5F5F5;" + |
-* Family history
-* Seasonal variation
-|-
-| style="background:#DCDCDC;" align="center" + |'''[[Chronic obstructive pulmonary disease|Acute Bronchitis]]'''<ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Acute
-| style="background:#F5F5F5;" + |
-* From 5 days to 1 or 3 weeks
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +/−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheezing]]
+*[[Wheeze|Wheezing]] (expiratory)
-* [[Rhonchi]]
+*[[Rales]]
+*[[Rhonchi]]
 | style="background:#F5F5F5;" + |
-* [[Sputum culture]] is not indicated
+*[[Eosinophilia]]
-* [[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
+*Total [[serum]] [[Immunoglobulin E|IgE]] in test for [[allergy]] may be helpful
 | style="background:#F5F5F5;" + |
-* [[Chest X-ray|Chest X−ray]] to exclude other diseases
+*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
+*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  x−ray]]
 | style="background:#F5F5F5;" + |
-* FEV1 < 80%
+*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
+*After physical active [[FEV1]] decreases by >15%
+*After inhaled [[corticosteroid]] (ICS)[[FEV1]] increased by >15%
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis
+*Airflow limitation on [[spirometry]]
 | style="background:#F5F5F5;" + |
-* Majority of cases are caused by [[respiratory]] [[viruses]]
+*Family history
+*Seasonal variation
 |-
-| style="background:#DCDCDC;" align="center" + |[[Chronic bronchitis|'''Chronic Bronchitis''']]<ref name="pmid24692133">{{cite journal |vauthors=Brusasco V, Martinez F |title=Chronic obstructive pulmonary disease |journal=Compr Physiol |volume=4 |issue=1 |pages=1–31 |year=2014 |pmid=24692133 |doi=10.1002/cphy.c110037 |url=}}</ref><ref name="pmid17975186">{{cite journal |vauthors=Qaseem A, Snow V, Shekelle P, Sherif K, Wilt TJ, Weinberger S, Owens DK |title=Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians |journal=Ann. Intern. Med. |volume=147 |issue=9 |pages=633–8 |year=2007 |pmid=17975186 |doi= |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Bacterial Protracted Bronchitis]]<ref name="pmid32228653">{{cite journal |vauthors=Zhang XB, Wu X, Nong GM |title=Update on protracted bacterial bronchitis in children |journal=Ital J Pediatr |volume=46 |issue=1 |pages=38 |date=March 2020 |pmid=32228653 |pmc=7106696 |doi=10.1186/s13052-020-0802-z |url=}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/patients/patient-resources/resources/pbb-in-children.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Chronic
 | style="background:#F5F5F5;" + |
-* Most of the days for three months in the las two years.
+*At least four weeks
-| style="background:#F5F5F5;" align="center" + | + Clear [[sputum]]
+| style="background:#F5F5F5;" align="center" + | +(Purulent)
-| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + | +/−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*[[Wheezing]]
-* [[Rhonchi]]
+*[[Rhonchi]]
-| style="background:#F5F5F5;" + |
-* [[CBC]] and [[ABG]] may be helpful
-| style="background:#F5F5F5;" + |
-* [[Chest X-ray|Chest X−Ray]] to exclude other diseases
-* [[Computed tomography|CT]] may also be helpful
-| style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio]] < 70%
-* Post bronchodilatador [[FEV1]] > 80%
-* Reduced [[Vital capacity|FVC]] after bronchodilatador administration
-* Decread [[vital capacity]]
-* Increased [[total lung capacity]]
-| style="background:#F5F5F5;" + |
-* Demostration of airflow limitation on [[spirometry]]
-| style="background:#F5F5F5;" + |
-* [[Smoker's cough]]
-* Cigarette smoking
-* Pollution
-|-
-| style="background:#DCDCDC;" align="center" + |'''Non−asthmatic eosinophilic bronchitis'''<ref name="pmid16428700">{{cite journal |vauthors=Brightling CE |title=Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=116S–121S |year=2006 |pmid=16428700 |doi=10.1378/chest.129.1_suppl.116S |url=}}</ref><ref name="pmid29317659">{{cite journal| author=Cho J, Choi SM, Lee J, Park YS, Lee SM, Yoo CG et al.| title=Clinical Outcome of Eosinophilic Airway Inflammation in Chronic Airway Diseases Including Nonasthmatic Eosinophilic Bronchitis. | journal=Sci Rep | year= 2018 | volume= 8 | issue= 1 | pages= 146 | pmid=29317659 | doi=10.1038/s41598-017-18265-2 | pmc=5760521 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29317659  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* More than 8 weeks
-| style="background:#F5F5F5;" align="center" + | + [[Eosinophilic]] [[sputum]]
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
-* [[Shortness of breath]]
 | style="background:#F5F5F5;" + |
-* High levels of [[Immunoglobulin E|IgE]]
+*[[Sputum culture]] is not indicated
-* Airway [[eosinophilia]] in [[sputum]] induction or bronchial wash fluid from [[bronchoscopy]] ([[bronchoalveolar lavage]])
+*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
 | style="background:#F5F5F5;" + |
-* Normal [[chest X-Ray|chest X−Ray]]
+*[[Chest X-ray|Chest x−ray]] to exclude other diseases
 | style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio|FEV1/FVC]] >70%
+*FEV1 < 80%
-* No response of short acting [[bronchodilator]]
 | style="background:#F5F5F5;" + |
-* [[Bronchial]] [[biopsy]]
+*Clinical diagnosis
-* [[Eosinophilia]]
 | style="background:#F5F5F5;" + |
-* Exposure to an occupational cause
+*Majority of cases are caused by Streptococci Pneumoniae, Hemophylous Influenza, Staphylococcus aureus
 |-
-| style="background:#DCDCDC;" align="center" + |[[Bronchiectasis|'''Bronchiectasis''']]<ref name="pmid166509702">{{cite journal |vauthors=King PT, Holdsworth SR, Freezer NJ, Villanueva E, Holmes PW |title=Characterisation of the onset and presenting clinical features of adult bronchiectasis |journal=Respir Med |volume=100 |issue=12 |pages=2183–9 |year=2006 |pmid=16650970 |doi=10.1016/j.rmed.2006.03.012 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Bronchiectasis|Bronchiectasis]]'''<ref name="pmid28611970">{{cite journal |vauthors=Pizzutto SJ, Hare KM, Upham JW |title=Bronchiectasis in Children: Current Concepts in Immunology and Microbiology |journal=Front Pediatr |volume=5 |issue= |pages=123 |date=2017 |pmid=28611970 |pmc=5447051 |doi=10.3389/fped.2017.00123 |url=}}</ref><ref name="pmid19135586">{{cite journal |vauthors=Redding GJ |title=Bronchiectasis in children |journal=Pediatr Clin North Am |volume=56 |issue=1 |pages=157–71, xi |date=February 2009 |pmid=19135586 |doi=10.1016/j.pcl.2008.10.014 |url=}}</ref><ref name="pmid19213492">{{cite journal |vauthors=Bouyahia O, Essadem L, Matoussi N, Gharsallah L, Fitouri Z, Mrad Mazigh S, Boukthir S, Bellagah I, Ben Becher S, Sammoud El Gharbi A |title=Etiology and outcome of bronchiectasis in children: a study of 41 patients |journal=Tunis Med |volume=86 |issue=11 |pages=996–9 |date=November 2008 |pmid=19213492 |doi= |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Chronic
 | style="background:#F5F5F5;" + |
-* Months to years
+*Months to years
 | style="background:#F5F5F5;" align="center" + | + Mucopurulent [[sputum]]
 | style="background:#F5F5F5;" align="center" + | +
@@ Line 481: / Line 426: @@
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Rales|Crackles]]
+*[[Rales|Crackles]]
-* [[Wheeze|Wheezing]]
+*[[Wheeze|Wheezing]]
-* [[Shortness of breath]]
+*[[Shortness of breath]]
+*[[Chest Pain]]
 | style="background:#F5F5F5;" + |
-* [[Complete blood count]] ([[Complete blood count|CBC]])
+*[[Complete blood count]] ([[Complete blood count|CBC]])
-* [[Immunoglobulin G|IgG]], [[Immunoglobulin M|IgM]] and [[Immunoglobulin A|IgA]]
+*Sweat Test, CFTR Gene analysis
-* [[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
+*Ciliary motility test, Nitric Oxide Test, Ciliary structures, Genetic Testing
+*[[Immunoglobulin G|IgG]], [[Immunoglobulin M|IgM]] and [[Immunoglobulin A|IgA]]
+*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
 | style="background:#F5F5F5;" + |
-* Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest X−Ray]]
+*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest x−ray]]
+*Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.
 | style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio|FEV1/FVC]] <70%
+*[[FEV1/FVC ratio|FEV1/FVC]] <70%
-* Normal [[Vital capacity|FVC]]
+*Normal [[Vital capacity|FVC]]
-* Low levels of [[Spirometry|FEV1]]
+*Low levels of [[Spirometry|FEV1]]
 | style="background:#F5F5F5;" a+ |
-* [[Computed tomography|CT]] of chest
+*[[Computed tomography|CT]] of chest
-| style="background:#F5F5F5;" + |
-* [[Digital clubbing]]
-* Recurrent [[pleurisy]]
-|-
-| style="background:#DCDCDC;" align="center" + |'''[[Emphysema]]''' <ref name="pmid28919728">{{cite journal| author=Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N et al.| title=Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. | journal=Int J Chron Obstruct Pulmon Dis | year= 2017 | volume= 12 | issue=  | pages= 2593-2610 | pmid=28919728 | doi=10.2147/COPD.S132236 | pmc=5587130 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28919728  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Months to years
-| style="background:#F5F5F5;" align="center" + | + Mucoid or purulent [[sputum]]
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* Shortness of [[Breathing|breath]]
-* [[Wheeze|Wheezing]]
-* Prolonged [[Exhalation|expiration]]
-* [[Rales|Crackles]]
-| style="background:#F5F5F5;" + |
-* Testing for [[alpha 1-antitrypsin|alpha 1−antitrypsin]] may be helpful
-| style="background:#F5F5F5;" + |
-* [[Chest X-ray|Chest X−Ray]] to exclude other diseases
-* [[Computed tomography|CT]] may also be helpful
-| style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio|FEV1/FVC]] <70%
-* Post [[bronchodilator]] [[FEV1]] >80
-| style="background:#F5F5F5;" + |
-* Detection of early [[emphysema]] in [[Computed tomography|CT]] of chest
 | style="background:#F5F5F5;" + |
-* Exposure of tobacco and air pollution
+*[[Digital clubbing]]
+*Recurrent [[pleurisy]]
 |-
-| style="background:#DCDCDC;" align="center" + |'''Foreing body [[Aspiration of foreign body|aspiration]]'''<ref name="pmid29221325">{{cite journal| author=Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F| title=Foreign body aspiration in adult airways: therapeutic approach. | journal=J Thorac Dis | year= 2017 | volume= 9 | issue= 9 | pages= 3398-3409 | pmid=29221325 | doi=10.21037/jtd.2017.06.137 | pmc=5708401 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29221325  }}</ref><ref name="pmid11444115">{{cite journal |vauthors=Rafanan AL, Mehta AC |title=Adult airway foreign body removal. What's new? |journal=Clin. Chest Med. |volume=22 |issue=2 |pages=319–30 |year=2001 |pmid=11444115 |doi= |url=}}</ref><ref name="pmid26568942">{{cite journal| author=Haddadi S, Marzban S, Nemati S, Ranjbar Kiakelayeh S, Parvizi A, Heidarzadeh A| title=Tracheobronchial Foreign-Bodies in Children; A 7 Year Retrospective Study. | journal=Iran J Otorhinolaryngol | year= 2015 | volume= 27 | issue= 82 | pages= 377-85 | pmid=26568942 | doi= | pmc=4639691 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26568942  }}</ref>
+| style="background:#DCDCDC;" align="center" + |'''Foreign body [[Aspiration of foreign body|aspiration]]''<ref name="pmid18345450">{{cite journal |vauthors=Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC |title=Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment |journal=J Bras Pneumol |volume=34 |issue=2 |pages=74–82 |date=February 2008 |pmid=18345450 |doi=10.1590/s1806-37132008000200003 |url=}}</ref><ref name="pmid31217709">{{cite journal |vauthors=Aslan N, Yıldızdaş D, Özden Ö, Yöntem A, Horoz ÖÖ, Kılıç S |title=Evaluation of foreign body aspiration cases in our pediatric intensive care unit: Single-center experience |journal=Turk Pediatri Ars |volume=54 |issue=1 |pages=44–48 |date=2019 |pmid=31217709 |pmc=6559979 |doi=10.14744/TurkPediatriArs.2019.60251 |url=}}</ref><ref name="pmid12736750">{{cite journal |vauthors=Ayed AK, Jafar AM, Owayed A |title=Foreign body aspiration in children: diagnosis and treatment |journal=Pediatr Surg Int |volume=19 |issue=6 |pages=485–8 |date=August 2003 |pmid=12736750 |doi=10.1007/s00383-003-0965-x |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" align="center" + |
-* Variable
+*Sudden Onset
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + | +/-
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + | +/-
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*[[Wheeze|Wheezing]], [[Inspiratory]] or [[Biphasic Strioor]]
-* Decreased [[breath sounds]]
+*Unilateral Decreased [[breath sounds]]
+*[[Cyanosis]]
 | style="background:#F5F5F5;" + |
-* No specific tests
+*No specific tests
 | style="background:#F5F5F5;" + |
-* Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
+*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
-* Shift in [[Chest X-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
+*Shift in [[Chest x-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
-* [[Computed tomography|CT]] may be helpful
+*[[Computed tomography|CT]] may be helpful
 | style="background:#F5F5F5;" + |
-* Not specific
+*Not specific
 | style="background:#F5F5F5;" + |
-* [[Bronchoscopy]]
+*[[Bronchoscopy]]
 | style="background:#F5F5F5;" + |
-* In children <1 year and adults >75 years
+*In children <1 year
-* Organic materials in children
+*Organic materials in children
-* Inorganic materials in adults
 |-
-| style="background:#DCDCDC;" align="center" + |[[Bronchiolitis|'''Bronchiolitis''']]<ref name="pmid14757603">{{cite journal |vauthors=Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L, Lohr KN |title=Diagnosis and testing in bronchiolitis: a systematic review |journal=Arch Pediatr Adolesc Med |volume=158 |issue=2 |pages=119–26 |year=2004 |pmid=14757603 |doi=10.1001/archpedi.158.2.119 |url=}}</ref><ref name="urlwww.nice.org.uk">{{cite web |url=https://www.nice.org.uk/guidance/ng9/resources/bronchiolitis-in-children-diagnosis-and-management-pdf-51048523717 |title=www.nice.org.uk |format= |work= |accessdate=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Bronchiolitis|Bronchiolitis]]'''<ref name="pmid25414585">{{cite journal |vauthors=Friedman JN, Rieder MJ, Walton JM |title=Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age |journal=Paediatr Child Health |volume=19 |issue=9 |pages=485–98 |date=November 2014 |pmid=25414585 |pmc=4235450 |doi=10.1093/pch/19.9.485 |url=}}</ref><ref name="pmid28084708">{{cite journal |vauthors=Smith DK, Seales S, Budzik C |title=Respiratory Syncytial Virus Bronchiolitis in Children |journal=Am Fam Physician |volume=95 |issue=2 |pages=94–99 |date=January 2017 |pmid=28084708 |doi= |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* 8−15 days
+*8−15 days
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + |−
@@ Line 564: / Line 486: @@
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*Rhinorrhoea
-* [[Rales|Crackles]]
+*Cyanosis, Hypoxia
-* Increased [[respiratory rate]]
+*Intercostal and subcostal retraction
+*Tachypnea
+*[[Wheeze|Wheezing]]
+*[[Rales|Crackles]]
+*Grunting and Nasal Flaring
 | style="background:#F5F5F5;" + |
-* [[Complete blood count]] ([[CBC]]) may be helpful
+*[[Complete blood count]] ([[CBC]]) may be helpful
-* [[Urinalysis]] & [[urine culture]] ( in infants)
+*[[Urinalysis]] & [[urine culture]] ( in infants)
 | style="background:#F5F5F5;" + |
-* [[Chest X-Ray|Chest X−Ray]] may be helpful
+*[[Chest X-Ray|Chest x−ray]] may be helpful
 | style="background:#F5F5F5;" + |
-* Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
+*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
-* Air trapping in [[Lung volumes]]
+*Air trapped in [[Lungs]]
-* Reduced [[DLCO|Diffusing capacity of carbon monoxide]] ( [[DLCO]])
+*Decreased  [[DLCO|Diffusing capacity of Carbon Monoxide]] ( [[DLCO]])
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis
+*Clinical diagnosis
 | style="background:#F5F5F5;" + |
-* Etiology: Respiratory ''[[Human respiratory syncytial virus|syncytial virus]], [[Rhinovirus]]''
+*Etiology: Respiratory ''[[Human respiratory syncytial virus|syncytial virus]], [[Rhinovirus]]''
-* Children <2 years
+*Children <2 years
 |-
 ! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 595: / Line 521: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight lost
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ascultation
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
@@ Line 604: / Line 530: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
 |-
-| rowspan="6" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
+| rowspan="2" style="background:#DCDCDC;" align="center" + |[[Respiratory system|'''Respiratory''']]
-| rowspan="6" style="background:#DCDCDC;" align="center" + |[[Parenchyma|'''Parenchyma''']]
+| rowspan="2" style="background:#DCDCDC;" align="center" + |[[Lung Parenchyma]]
-| style="background:#DCDCDC;" align="center" + |[[Pneumonia|'''Pneumonia''']]<ref name="pmid10987697">{{cite journal |vauthors=Bartlett JG, Dowell SF, Mandell LA, File Jr TM, Musher DM, Fine MJ |title=Practice guidelines for the management of community-acquired pneumonia in adults. Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=31 |issue=2 |pages=347–82 |year=2000 |pmid=10987697 |doi=10.1086/313954 |url=}}</ref><ref name="pmid17278083">{{cite journal |vauthors=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=Clin. Infect. Dis. |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |pmid=17278083 |doi=10.1086/511159 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Pneumonia]]<ref name="pmid29269189">{{cite journal |vauthors=Katz SE, Williams DJ |title=Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research |journal=Infect Dis Clin North Am |volume=32 |issue=1 |pages=47–63 |date=March 2018 |pmid=29269189 |pmc=5801082 |doi=10.1016/j.idc.2017.11.002 |url=}}</ref><ref name="pmid29237789">{{cite journal |vauthors=Rodrigues CMC, Groves H |title=Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis |journal=J Clin Microbiol |volume=56 |issue=3 |pages= |date=March 2018 |pmid=29237789 |pmc=5824044 |doi=10.1128/JCM.01318-17 |url=}}</ref><ref name="pmid22403224">{{cite journal |vauthors=Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, Bhat N, Murdoch DR, Crawley J, Levine OS, O'Brien KL, Feikin DR |title=The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study |journal=Clin Infect Dis |volume=54 Suppl 2 |issue= |pages=S109–16 |date=April 2012 |pmid=22403224 |pmc=3297550 |doi=10.1093/cid/cir1065 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* Variable
+| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | + Mucopurulent [[sputum]]
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |−
@@ Line 616: / Line 541: @@
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Rales|Crackles]]
+*[[Rales|Crackles]]
-* [[Egophony]]
+*[[Egophony]]
-* Decreased bronchial sounds
+*Decreased bronchial sounds, Rhonchi
+*Rapid Breathing
+*Intercostal retractions
+*Nasal Flaring, Grunting
+*Tachypnea, Tachycardia
+*Vomiting
 | style="background:#F5F5F5;" + |
-* Leftward shift [[leukocytosis]]
+*Leftward shift [[leukocytosis]]
-* [[Blood culture]] in hospitalized patients
+*[[Blood culture]] in hospitalized patients
-* [[Sputum culture]] in hospitalized patients
+*[[Sputum culture]] in hospitalized patients
 | style="background:#F5F5F5;" + |
-* [[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest X−ray]]
+*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest x−ray]]
-* Anatomical changes observed in chest [[Computed tomography|CT]]
+*Anatomical changes observed in chest [[Computed tomography|CT]]
 | style="background:#F5F5F5;" + |
-* Not specific
+*Not specific
 | style="background:#F5F5F5;" + |
-* Infiltration observed in [[chest X-ray|chest X−ray]]
+*Infiltration observed in [[chest X-ray|chest x−ray]]
 | style="background:#F5F5F5;" + |
-* [[Community-acquired pneumonia|Community−acquired pneumonia]]
+*[[Community-acquired pneumonia|Community−acquired pneumonia]]
-* [[Healthcare-associated pneumonia|Healthcare−associated pneumonia]]
+*[[Healthcare-associated pneumonia|Healthcare−associated pneumonia]]
 |-
-| style="background:#DCDCDC;" align="center" + |[[Pneumoconiosis|'''Pneumoconioses''']]<ref name="pmid27980247">{{cite journal |vauthors=Jp NA, Imanaka M, Suganuma N |title=Japanese workplace health management in pneumoconiosis prevention |journal=J Occup Health |volume=59 |issue=2 |pages=91–103 |year=2017 |pmid=27980247 |pmc=5478517 |doi=10.1539/joh.16-0031-RA |url=}}</ref><ref name="pmid12668748">{{cite journal |vauthors=Weiland DA, Lynch DA, Jensen SP, Newell JD, Miller DE, Crausman RS, Kuhn C, Kern DG |title=Thin-section CT findings in flock worker's lung, a work-related interstitial lung disease |journal=Radiology |volume=227 |issue=1 |pages=222–31 |year=2003 |pmid=12668748 |doi=10.1148/radiol.2271011063 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |'''[[Tuberculosis]] ([[Tuberculosis|TB]])'''<ref name="pmid28734517">{{cite journal |vauthors=Thomas TA |title=Tuberculosis in Children |journal=Pediatr Clin North Am |volume=64 |issue=4 |pages=893–909 |date=August 2017 |pmid=28734517 |pmc=5555046 |doi=10.1016/j.pcl.2017.03.010 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Acute, Chronic
+| style="background:#F5F5F5;" align="center" + |Chronic<ref name="pmid25037105">{{cite journal |vauthors=Marais BJ, Schaaf HS |title=Tuberculosis in children |journal=Cold Spring Harb Perspect Med |volume=4 |issue=9 |pages=a017855 |date=July 2014 |pmid=25037105 |pmc=4143109 |doi=10.1101/cshperspect.a017855 |url=}}</ref>
 | style="background:#F5F5F5;" + |
-* Years
+*Weeks to months
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
-* [[Rhonchi]]
-* [[Rales|Crackles]]
-| style="background:#F5F5F5;" + |
-* [[CBC]] and [[ABG]] may be helpful
-| style="background:#F5F5F5;" + |
-* Small oppacities and [[fibrosis]] observed in [[chest X-ray|chest X−ray]]
-* [[Computed tomography|CT]] and [[Positron emission tomography|FDG−PET]] may be helpful
-| style="background:#F5F5F5;" + |
-* [[FEV1/FVC ratio|FEV1/FVC]] <70%
-* [[FEV1]] <80%
-| style="background:#F5F5F5;" + |
-* Exposure history  and [[Chest X-ray|chest radiograph]]
-| style="background:#F5F5F5;" + |
-* Fibrogenic: [[Silica]], [[asbestos]]
-* Inert: [[Iron]], [[barium]]
-* Granulomatous: [[Beryllium]]
-* Giant cell pneumonia: [[Cobalt]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Lung cancer|'''Lung cancer''']]<ref name="pmid21296855">{{cite journal |vauthors=Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D |title=Global cancer statistics |journal=CA Cancer J Clin |volume=61 |issue=2 |pages=69–90 |year=2011 |pmid=21296855 |doi=10.3322/caac.20107 |url=}}</ref><ref name="pmid23649435">{{cite journal |vauthors=Ost DE, Jim Yeung SC, Tanoue LT, Gould MK |title=Clinical and organizational factors in the initial evaluation of patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines |journal=Chest |volume=143 |issue=5 Suppl |pages=e121S–e141S |year=2013 |pmid=23649435 |pmc=4694609 |doi=10.1378/chest.12-2352 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Years
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +/−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Hoarseness]]
+*[[Pleural effusion]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Crackles]]
-* [[Complete blood count]] ([[Complete blood count|CBC]])
+*[[Whispered pectoriloquy]]
-* [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
+*Decreased fremitus
-* [[Calcium]]
+*[[Rhonchi]]
-* [[Alkaline phosphatase]]
-* [[Lactate dehydrogenase|LDH]]
-* [[Creatinine]]
-| style="background:#F5F5F5;" + |
-* [[Contrast enhanced CT|Contrast−enhanced CT]] of chest and upper abdomen
-| style="background:#F5F5F5;" + |
-* Not specific
-| style="background:#F5F5F5;" + |
-* Tissue [[biopsy]]  (sample should be sufficient for [[Molecule|molecular]] testing)
-| style="background:#F5F5F5;" + |
-* Risk factor:
-** Cigarette smoking
-* Types
-** [[Small cell lung cancer|Small cell lung cance]]<nowiki/>r ([[Small cell lung cancer|SCLC]])
-** [[Non small cell lung cancer|Non−small cell lung cance]]<nowiki/>r ([[Non small cell lung cancer|NSCLC]])
-|-
-| style="background:#DCDCDC;" align="center" + |'''[[Interstitial lung disease]]'''<ref name="pmid15331185">{{cite journal |vauthors=Lama VN, Martinez FJ |title=Resting and exercise physiology in interstitial lung diseases |journal=Clin. Chest Med. |volume=25 |issue=3 |pages=435–53, v |year=2004 |pmid=15331185 |doi=10.1016/j.ccm.2004.05.005 |url=}}</ref><ref name="pmid15133338">{{cite journal |vauthors=Chetta A, Marangio E, Olivieri D |title=Pulmonary function testing in interstitial lung diseases |journal=Respiration |volume=71 |issue=3 |pages=209–13 |year=2004 |pmid=15133338 |doi=10.1159/000077416 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Variable
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*Sputum [[Acid-fast|AFB]] stain may be +.
-* [[Rales|Crackles]] or velcro rales
+*[[Mycobacterium Tuberculosis]] [[Culture media|culture]] may be +
-* [[Lung volumes|Inspiratory]] high−pitched [[rhonchi]]
+*Molecular testing may be helpful
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
-* [[Hepatic function test]]
-* [[Renal function tests|Renal function test]]
-* [[Complete blood count|CBC]]
-* [[Serology|Serological testing]]
 | style="background:#F5F5F5;" + |
-* [[Nodular]], [[reticular]] or both pattern in [[chest X-ray|chest X−ray]]
+*Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest x−ray]]
-* [[Computed tomography|CT]] in patients with diffuse pulmonary lung disease
 | style="background:#F5F5F5;" + |
-* Reduction in [[Vital capacity|FVC]], [[Residual volume|RV]], [[Functional residual capacity|FRC]], [[Total lung capacity|TLC]] and [[FEV1]] on spirometry
+*Decreased [[FEV1]]
-* [[FEV1/FVC ratio|FEV1/FVC]] normal or increase
+*Reduced  [[Vital capacity|FVC]]
-* [[Lung volumes]]
-* Diffusion capacity ([[DLCO]] reduced)
 | style="background:#F5F5F5;" + |
-* Lung [[biopsy]] when lab, imaging, and PFT has indeterminate result
+*Isolation of ''[[Mycobacterium tuberculosis]]''
 | style="background:#F5F5F5;" + |
-* Clubbing is common in [[asbestosis]] and [[idiopathic pulmonary fibrosis]]
+*Etiology: ''[[Mycobacterium tuberculosis]]''
-|-
-| style="background:#DCDCDC;" align="center" + |'''[[Tuberculosis]] ([[Tuberculosis|TB]])'''<ref name="pmid9332519">{{cite journal |vauthors=Perlman DC, el-Sadr WM, Nelson ET, Matts JP, Telzak EE, Salomon N, Chirgwin K, Hafner R |title=Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. The Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). The AIDS Clinical Trials Group (ACTG) |journal=Clin. Infect. Dis. |volume=25 |issue=2 |pages=242–6 |year=1997 |pmid=9332519 |doi= |url=}}</ref><ref name="pmid2456183">{{cite journal |vauthors=Barnes PF, Verdegem TD, Vachon LA, Leedom JM, Overturf GD |title=Chest roentgenogram in pulmonary tuberculosis. New data on an old test |journal=Chest |volume=94 |issue=2 |pages=316–20 |year=1988 |pmid=2456183 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* More than 2 or 3 weeks
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Pleural effusion]]
-* [[Crackles]]
-* [[Whispered pectoriloquy]]
-* Decreased fremitus
-* [[Rhonchi]]
-| style="background:#F5F5F5;" + |
-* Sputum [[acid-fast|acid−fast]] bacilli ([[Acid-fast|AFB]]) smear may be positive
-* [[Mycobacterium|Mycobacterial]] [[Culture media|culture]] may be positive
-* Molecular testing may be helpful
-| style="background:#F5F5F5;" + |
-* Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest X−Ray]]
-* In patients with [[Human Immunodeficiency Virus (HIV)|HIV]], Tb is observed as lobar [[Infiltration (medical)|infiltration]], [[adenopathy]], lung mass named [[tuberculoma]], small fibronodular lesions, and/or [[pleural effusion]] on [[Chest X-ray|chest X−Ray]]
-* [[Computed tomography|CT]] can detect early nodal process
-| style="background:#F5F5F5;" + |
-* Decreased [[FEV1]]
-* Reduced  [[Vital capacity|FVC]]
-| style="background:#F5F5F5;" + |
-* Isolation of ''[[Mycobacterium tuberculosis]]'' from some [[secretion]]
-| style="background:#F5F5F5;" + |
-* Etiology: ''[[Mycobacterium tuberculosis]]''
-* Complications: [[Pneumothorax]], [[bronchiectasis]], pulmonary destruction and [[chronic pulmonary aspergillosis]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Cystic fibrosis|'''Cystic fibrosis''']]  ([[Cystic fibrosis|CF]])<ref name="pmid18639722">{{cite journal |vauthors=Farrell PM, Rosenstein BJ, White TB, Accurso FJ, Castellani C, Cutting GR, Durie PR, Legrys VA, Massie J, Parad RB, Rock MJ, Campbell PW |title=Guidelines for diagnosis of cystic fibrosis in newborns through older adults: Cystic Fibrosis Foundation consensus report |journal=J. Pediatr. |volume=153 |issue=2 |pages=S4–S14 |year=2008 |pmid=18639722 |pmc=2810958 |doi=10.1016/j.jpeds.2008.05.005 |url=}}</ref><ref name="pmid1285737">{{cite journal |vauthors=Kerem E, Reisman J, Corey M, Canny GJ, Levison H |title=Prediction of mortality in patients with cystic fibrosis |journal=N. Engl. J. Med. |volume=326 |issue=18 |pages=1187–91 |year=1992 |pmid=1285737 |doi=10.1056/NEJM199204303261804 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" align="center" + |
-* Variable
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +/−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* Barrel−shaped chest
-* [[Wheezing]]
-* [[Tachypnea]]
-| style="background:#F5F5F5;" + |
-* [[Respiratory tract]] [[Culture media|culture]] may be helpful for diagnosing secondary bacterial infection
-* [[Bronchoalveolar lavage]] for cytology may be helpful
-* ≥ 60 mmol/L [[Sweat chloride test]]
-* [[CFTR (gene)|CFTR]] [[mutation]] in molecular testing may be positive
-| style="background:#F5F5F5;" + |
-* Hyperinflation, [[atelectasis]], and infiltrates on [[Chest X-ray|chest X−Ray]]
-* Severe patients present bronchietasis, "tram tracks" [[Peribronchial cuffing|peribronchial cuffin]]<nowiki/>g in [[Chest X-ray|chest X−Ray]]
-* The extension of [[bronchietasis]] can be defined by [[Computed tomography|CT]]
-| style="background:#F5F5F5;" + |
-* [[Residual volume|RV]]/[[Total lung capacity|TLC]] ratio increased
-* [[FEV1/FVC ratio]] <70%
-* Low levels of [[FEV1]]
-* High levels of [[Total lung capacity|TLC]]
-* [[Residual volume|RV]] increased
-| style="background:#F5F5F5;" + |
-* [[Sweat chloride test]]
-| style="background:#F5F5F5;" + |
-* Evidence of [[Cystic fibrosis transmembrane conductance regulator|CFTR]] dysfunction
 |-
 ! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 803: / Line 606: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight lost
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ascultation
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
@@ Line 812: / Line 615: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
 |-
-| colspan="2" rowspan="3" style="background:#DCDCDC;" align="center" + |[[Heart|'''Cardiac''']]
+| colspan="2" rowspan="2" style="background:#DCDCDC;" align="center" + |[[Heart|'''Cardiac''']]
-| style="background:#DCDCDC;" align="center" + |[[Pulmonary edema|'''Cardiogenic pulmonary edema''']]<ref name="pmid16365214">{{cite journal |vauthors=Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L |title=Acute heart failure syndromes: current state and framework for future research |journal=Circulation |volume=112 |issue=25 |pages=3958–68 |year=2005 |pmid=16365214 |doi=10.1161/CIRCULATIONAHA.105.590091 |url=}}</ref><ref name="pmid23741058">{{cite journal |vauthors=Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL |title=2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines |journal=Circulation |volume=128 |issue=16 |pages=e240–327 |year=2013 |pmid=23741058 |doi=10.1161/CIR.0b013e31829e8776 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Cardiac Failure]]<ref name="urlCough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK154448/ |title=Cough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid27867456">{{cite journal |vauthors=Jayaprasad N |title=Heart Failure in Children |journal=Heart Views |volume=17 |issue=3 |pages=92–99 |date=2016 |pmid=27867456 |pmc=5105230 |doi=10.4103/1995-705X.192556 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Acute
 | style="background:#F5F5F5;" + |
-* Days to weeks
+*Hours
-| style="background:#F5F5F5;" align="center" + | + Pink frothy, liquid
+| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Rales|Crackles]]
+*[[Rales|Crackles]]
-* Increased [[respiratory rate]]
+*Increased [[respiratory rate]], [[retraction]]
-* [[Wheeze|Wheezing]]
+*[[Wheeze|Wheezing]], [[Grunting]], [[Nasal flaring]]
-* [[Rhonchi]]
+*[[JVD]]
-* Gurgling sounds
+*Displacement of apex beat
+*Gallop rhythm, Murmur may present.
+*Hepatomegaly, Ascites
 | style="background:#F5F5F5;" + |The following investigations may be helpful:
-* [[Arterial blood gas]]
-* [[Blood urea nitrogen|BUN]]
+*[[Arterial blood gas]]
-* [[Serum creatinine|Serum creatinin]]
+*[[Blood urea nitrogen|BUN]]
-* Serum [[troponin]]
+*[[Serum creatinine|Serum creatinin]]
-* [[Electrolyte|Electrolytes]]
+*Serum [[troponin]]
-* [[Lactic acid]]
+*[[Electrolyte|Electrolytes]]
-* [[Complete blood count]]
+*[[Lactic acid]]
+*[[Complete blood count]]
 | style="background:#F5F5F5;" + |
-* [[Cardiomegaly]], [[pleural effusion]], interstitial [[edema]], alveolar [[edema]] and blood redistribution in lower lobes in [[chest X-ray|chest X−ray]]
+*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest x−ray]]
 | style="background:#F5F5F5;" + |
-* Not specific
+*Not specific
 | style="background:#F5F5F5;" + |
-* Clinical diagnosis
+*Clinical diagnosis
-* Tests are supportive
+*Tests are supportive
 | style="background:#F5F5F5;" + |
-* [[12-lead ECG|12−lead ECG]]
+*[[12-lead ECG|12−lead ECG]]
-* Plasma [[Brain natriuretic peptide|BNP]] and [[NT-proBNP|NT−proBNP]]
+*Plasma [[Brain natriuretic peptide|BNP]] and [[NT-proBNP|NT−proBNP]]
-* [[Echocardiography]]
+*[[Echocardiography]]
 |-
-| style="background:#DCDCDC;" align="center" + |[[Mitral stenosis|'''Mitral Stenosis''']]<ref name="pmid13936649">{{cite journal| author=MUNROE DS, RALLY CR| title=The diagnosis of mitral stenosis. | journal=Can Med Assoc J | year= 1963 | volume= 88 | issue=  | pages= 611-22 | pmid=13936649 | doi= | pmc=1921207 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13936649  }}</ref><ref name="pmid19747723">{{cite journal |vauthors=Chandrashekhar Y, Westaby S, Narula J |title=Mitral stenosis |journal=Lancet |volume=374 |issue=9697 |pages=1271–83 |year=2009 |pmid=19747723 |doi=10.1016/S0140-6736(09)60994-6 |url=}}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Congenital Heart Disease]]
-| style="background:#F5F5F5;" align="center" + |Chronic
+| style="background:#F5F5F5;" align="center" + |Acute or Chronic
 | style="background:#F5F5F5;" + |
-* Variable
+*Variable
-| style="background:#F5F5F5;" align="center" + | + Pink frothy
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Crackles]]
-* [[Hoarseness]]
-| style="background:#F5F5F5;" + |
-* Not specifc
-| style="background:#F5F5F5;" + |
-* [[Electrocardiogram]] may be helpful
-* Enlargement of [[left atrium]] and [[appendage]] in [[Chest X-ray|chest radiograph]]
-| style="background:#F5F5F5;" + |
-* [[Vital capacity|FVC]] reduced
-| style="background:#F5F5F5;" + |
-* Resting [[transthoracic echocardiography]]
-| style="background:#F5F5F5;" + |
-* [[Stress testing]]
-* [[Cardiac catheterization]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Pulmonary hypertension|'''Pulmonary hypertension''']]<ref name="pmid21393391">{{cite journal |vauthors=Brown LM, Chen H, Halpern S, Taichman D, McGoon MD, Farber HW, Frost AE, Liou TG, Turner M, Feldkircher K, Miller DP, Elliott CG |title=Delay in recognition of pulmonary arterial hypertension: factors identified from the REVEAL Registry |journal=Chest |volume=140 |issue=1 |pages=19–26 |year=2011 |pmid=21393391 |pmc=3198486 |doi=10.1378/chest.10-1166 |url=}}</ref><ref name="pmid12651053">{{cite journal| author=Sun XG, Hansen JE, Oudiz RJ, Wasserman K| title=Pulmonary function in primary pulmonary hypertension. | journal=J Am Coll Cardiol | year= 2003 | volume= 41 | issue= 6 | pages= 1028-35 | pmid=12651053 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12651053  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* More than 2 years
-| style="background:#F5F5F5;" align="center" + | −
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
+| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Dysphonia|Hoarseness]]
+*[[Crackles]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*[[Hoarseness]]
-* [[Human Immunodeficiency Virus (HIV)|HIV]] serology
-* [[Anti-nuclear antibody|Antinuclear antibody]] ([[Antinuclear antibodies|ANA]])
-* [[Rheumatoid factor]] ([[RF]])
-* [[Anti-neutrophil  cytoplasmic antibody|Anti−neutrophil  cytoplasmic antibody]] ([[Anti-neutrophil cytoplasmic antibody|ANCA]])
-| style="background:#F5F5F5;" + |
-* Enlargement of the central [[pulmonary artery]] and right heart  in [[Chest X-ray|chest X−Ray]]
-* [[Pulmonary  artery]] systolic pressure can be estimated in [[echocardiography]]
-| style="background:#F5F5F5;" + |
-* Low levels of [[FEV1]]
-* Decreased [[Vital capacity|FVC]]
-* [[DLCO]] reduced
-| style="background:#F5F5F5;" + |
-* Mean [[pulmonary artery]] pressure more than 25 [[mmHg]] at rest
-| style="background:#F5F5F5;" + |
-* [[Chest pain]]
-* [[Ascites]]
-* [[Syncope]]
-* Peripherial [[edema]]
-|-
-| colspan="2" style="background:#DCDCDC;" align="center" + |[[Gastrointestinal tract|'''Gastrointestinal''']]
-| style="background:#DCDCDC;" align="center" + |[[Gastroesophageal reflux disease|'''Gastroesophageal reflux''']]<ref name="pmid21508423">{{cite journal |vauthors=Kahrilas PJ, Hughes N, Howden CW |title=Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease |journal=Gut |volume=60 |issue=11 |pages=1473–8 |year=2011 |pmid=21508423 |doi=10.1136/gut.2011.241307 |url=}}</ref><ref name="pmid25133039">{{cite journal| author=Badillo R, Francis D| title=Diagnosis and treatment of gastroesophageal reflux disease. | journal=World J Gastrointest Pharmacol Ther | year= 2014 | volume= 5 | issue= 3 | pages= 105-12 | pmid=25133039 | doi=10.4292/wjgpt.v5.i3.105 | pmc=4133436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25133039  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Variable
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*Not specific
-* [[Hoarseness]]
 | style="background:#F5F5F5;" + |
-* Not specific
+*[[Electrocardiogram]] may be helpful
+*Enlargement of [[left atrium]] and [[appendage]] in [[Chest X-ray|chest radiograph]]
 | style="background:#F5F5F5;" + |
-* [[Upper endoscopy]] may be helpful
+*[[Vital capacity|FVC]] reduced
-* [[Barium]] esophagram may be helpful
 | style="background:#F5F5F5;" + |
-* Normal function
+*Resting [[transthoracic echocardiography]]
 | style="background:#F5F5F5;" + |
-* PH testing
+*[[Stress testing]]
-| style="background:#F5F5F5;" align="center" + | −−
+*[[Cardiac catheterization]]
 |-
 ! colspan="2" rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Organ system
@@ Line 941: / Line 692: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Productive cough
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hemoptysis
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight lost
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Dyspnea
-! style="background:#4479BA; color: #FFFFFF;" align="center" + |Ascultation
+! style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical Examination
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Imaging
@@ Line 950: / Line 701: @@
 ! style="background:#4479BA; color: #FFFFFF;" align="center" + |Gold standard
 |-
-| colspan="2" rowspan="5" style="background:#DCDCDC;" align="center" + |'''[[Autoimmune]]'''
+| colspan="2" style="background:#DCDCDC;" align="center" + |[[Gastrointestinal tract|'''Gastrointestinal''']]
-| style="background:#DCDCDC;" align="center" + |[[Goodpasture syndrome|'''Goodpasture syndrome''']]<ref name="pmid3728460">{{cite journal |vauthors=Boyce NW, Holdsworth SR |title=Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage |journal=Am. J. Kidney Dis. |volume=8 |issue=1 |pages=31–6 |year=1986 |pmid=3728460 |doi= |url=}}</ref><ref name="pmid27496347">{{cite journal| author=Foster MH| title=Basement membranes and autoimmune diseases. | journal=Matrix Biol | year= 2017 | volume= 57-58 | issue=  | pages= 149-168 | pmid=27496347 | doi=10.1016/j.matbio.2016.07.008 | pmc=5290253 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27496347  }}</ref>
+| style="background:#DCDCDC;" align="center" + |[[Gastroesophageal reflux disease|'''Gastroesophageal reflux''']]<ref name="pmid11683086">{{cite journal |vauthors=Juchet A, Brémont F, Dutau G, Olives JP |title=[Chronic cough and gastroesophageal reflux in children] |language=French |journal=Arch Pediatr |volume=8 Suppl 3 |issue= |pages=629–634 |date=August 2001 |pmid=11683086 |doi=10.1016/s0929-693x(01)80018-x |url=}}</ref><ref name="pmid16504152">{{cite journal |vauthors=Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, Withers GD, Patrick MK, Lewindon PJ |title=Cough and reflux esophagitis in children: their co-existence and airway cellularity |journal=BMC Pediatr |volume=6 |issue= |pages=4 |date=February 2006 |pmid=16504152 |pmc=1409774 |doi=10.1186/1471-2431-6-4 |url=}}</ref>
 | style="background:#F5F5F5;" align="center" + |Chronic
 | style="background:#F5F5F5;" + |
-* Variable
+*Variable
-| style="background:#F5F5F5;" align="center" + |−
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Shortness of breath]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
-* [[Complete blood count]] ([[Complete blood count|CBC]])
-* [[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
-* [[Goodpasture syndrome|Anti−GBM]] in [[Enzyme linked immunosorbent assay (ELISA)|ELISA]] or [[western blot]]
-| style="background:#F5F5F5;" + |
-* Pulmonary infiltratation in [[Chest X-ray|chest X−Ray]]
-* [[Computed tomography|CT]] scan for parenchymal involvement
-| style="background:#F5F5F5;" + |
-* Increased [[DLCO]]
-* Decreased [[Total lung capacity|TLC]]
-* Decreased [[Vital capacity|FVC]]
-| style="background:#F5F5F5;" + |
-* Renal [[biopsy]]
-| style="background:#F5F5F5;" + |
-* [[Hematuria]]
-* [[Proteinuria]]
-|-
-| style="background:#DCDCDC;" align="center" + |[[Granulomatosis with polyangiitis|'''Wegener's disease''']] ([[Granulomatosis with polyangiitis|'''GPA''']]) <ref name="pmid1739240">{{cite journal |vauthors=Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, Rottem M, Fauci AS |title=Wegener granulomatosis: an analysis of 158 patients |journal=Ann. Intern. Med. |volume=116 |issue=6 |pages=488–98 |year=1992 |pmid=1739240 |doi= |url=}}</ref><ref name="pmid21374588">{{cite journal |vauthors=Falk RJ, Gross WL, Guillevin L, Hoffman GS, Jayne DR, Jennette JC, Kallenberg CG, Luqmani R, Mahr AD, Matteson EL, Merkel PA, Specks U, Watts RA |title=Granulomatosis with polyangiitis (Wegener's): an alternative name for Wegener's granulomatosis |journal=Arthritis Rheum. |volume=63 |issue=4 |pages=863–4 |year=2011 |pmid=21374588 |doi=10.1002/art.30286 |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Months
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Hoarseness]]
-* [[Stridor]]
-* [[Wheeze|Wheezing]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
-* [[Anti-neutrophil cytoplasmic antibody|ANCA]], [[P-ANCA|P−ANCA]], [[C-ANCA|C−ANCA]]
-* [[Blood urea nitrogen|BUN]]
-* [[Creatinine]]
-* [[Complete blood count]]
-* [[Urinalysis]]
-* Lung [[biopsy]]
-| style="background:#F5F5F5;" + |
-* [[Nodules]], [[Lung|pulmonary]] infiltrates, reticular margins, pleural opacities and [[Cavity|cavities]] in [[Chest X-ray|chest X−Ray]]
-* [[Nodule (medicine)|Nodules]], [[cavities]] and stellate−shaped peripherial [[pulmonary]] in chest [[Computed tomography|CT]]
-* [[Bronchoscopy]] may be helpful
-| style="background:#F5F5F5;" + |
-* Low levels of [[DLCO]]
-* Reduce [[lung volumes]]
-| style="background:#F5F5F5;" + |
-* Tissue [[biopsy]]
-| style="background:#F5F5F5;" + |
-* Nasal crusting, sinus pain, chronic [[rhinosinusitis]], nasal obstruction and discharge in [[Upper respiratory tract|upper airway]]
-* [[Saddle nose|Saddle nose deformity]]
-* [[Purpura]] in lower extremities
-|-
-| style="background:#DCDCDC;" align="center" + |[[Sarcoidosis|'''Sarcoidosis''']]<ref name="pmid27378039">{{cite journal |vauthors=Carmona EM, Kalra S, Ryu JH |title=Pulmonary Sarcoidosis: Diagnosis and Treatment |journal=Mayo Clin. Proc. |volume=91 |issue=7 |pages=946–54 |year=2016 |pmid=27378039 |doi=10.1016/j.mayocp.2016.03.004 |url=}}</ref><ref name="pmid12803116">{{cite journal |vauthors=Yanardağ H, Pamuk GE, Karayel T, Demirci S |title=Bone marrow involvement in sarcoidosis: an analysis of 50 bone marrow samples |journal=Haematologia (Budap) |volume=32 |issue=4 |pages=419–25 |year=2002 |pmid=12803116 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Years
 | style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | −
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
+*[[Wheeze|Wheezing]]
-* Squeaky sounds
+*[[Hoarseness]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
+*Regurgitation, Vomiting
-* [[Complete blood count]] ([[CBC]])
+*Back Arching, crying
-* [[Urinalysis]]
-* [[Blood urea nitrogen|BUN]]
+  *Apnea
-* [[Liver function tests|Liver function test]]
-* [[Calcium]]
+*Epigastric pain
-* [[Alkaline phosphatase]] levels
-* [[Electrolyte|Electrolytes]]
-* [[Histopathology|Histopathologic]] detection
-| style="background:#F5F5F5;" + |
-* On [[Chest X-ray|chest X−Ray]]:
-** Stage 1: Bilateral hiliar [[adenopathy]]
-** Stage 2: [[Reticular]] opacities and hiliar adenopathy
-** Stage 3: Shrink hiliar [[Nodule (medicine)|nodules]] and [[reticular]] opacities
-** Stage 4: Lost of volume
-| style="background:#F5F5F5;" + |
-* Reduced [[FVC]]
-* Decreased of [[Total lung capacity|TLC]]
-| style="background:#F5F5F5;" + |
-* Clinical diagnosis, [[Histopathology|histopathologic]] detection of noncaseating [[Granuloma|granulomas]] and exclusion of other diseases
-| style="background:#F5F5F5;" + |
-* Young adults
-* [[Skin]], [[joint]] and [[eye]] lesions
-|-
-| style="background:#DCDCDC;" align="center" + |'''Microscopic polyangitis ([[Microscopic polyangiitis|MPA]])'''<ref name="JennetteFalk1997">{{cite journal|last1=Jennette|first1=J. Charles|last2=Falk|first2=Ronald J.|title=Small-Vessel Vasculitis|journal=New England Journal of Medicine|volume=337|issue=21|year=1997|pages=1512–1523|issn=0028-4793|doi=10.1056/NEJM199711203372106}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
 | style="background:#F5F5F5;" + |
-* Variable
+*Not specific
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
 | style="background:#F5F5F5;" + |
-* [[Hoarseness]]
+*[[Upper endoscopy]] may be helpful
-* [[Stridor]]
+*[[Barium]] esophagram may be helpful
-* [[Wheeze|Wheezing]]
-| style="background:#F5F5F5;" + |The following investigations may be helpful:
-* [[ANCA]] positive
-* [[Blood urea nitrogen|BUN]]
-* [[Creatinine]]
-* [[Complete blood count]]
-* [[Urinalysis]]
 | style="background:#F5F5F5;" + |
-* [[Cavitation]], [[Nodule (medicine)|nodules]], and alveolar opacities in [[chest X-ray|chest X−ray]]
+*Normal function
-* Head and chest [[Computed tomography|CT]] may be helpful
-* [[Electromyography]]/[[nerve conduction study]] may also be helpful
 | style="background:#F5F5F5;" + |
-* Reduced [[lung volumes]]
+*PH testing
-| style="background:#F5F5F5;" + |
+| style="background:#F5F5F5;" align="center" + |−−
-* Tissue [[biopsy]]
-| style="background:#F5F5F5;" + |
-* [[Nerve]] damage
-* [[Rhinosinusitis]]
-* [[Purpura]] involving lower extremities
-|-
-| style="background:#DCDCDC;" align="center" + |[[Eosinophilic granulomatosis with polyangiitis|'''Churg−Strauss''']]<ref name="pmid23330816">{{cite journal |vauthors=Vaglio A, Buzio C, Zwerina J |title=Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): state of the art |journal=Allergy |volume=68 |issue=3 |pages=261–73 |year=2013 |pmid=23330816 |doi=10.1111/all.12088 |url=}}</ref><ref name="pmid6366453">{{cite journal |vauthors=Lanham JG, Elkon KB, Pusey CD, Hughes GR |title=Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome |journal=Medicine (Baltimore) |volume=63 |issue=2 |pages=65–81 |year=1984 |pmid=6366453 |doi= |url=}}</ref>
-| style="background:#F5F5F5;" align="center" + |Chronic
-| style="background:#F5F5F5;" + |
-* Variable
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
-* [[Rales]]
-* [[Rhonchi]]
-* Expiratory sounds(related to [[asthma]])
-| style="background:#F5F5F5;" + |
-* Peripherial [[eosinophilia]]
-* In active phase [[C-reactive protein|CRP]] and [[Red blood cell|erytrocyte]] [[sedimentation]] rate high
-* Elevated [[Immunoglobulin E|IgE]]
-* [[Anti-neutrophil cytoplasmic antibody|ANCA]] positive
-| style="background:#F5F5F5;" + |
-* Infiltrates in [[Chest X-ray|chest X−Ray]]
-* Ground glass opacities, tree−in−bud sign and small nodules  in chest [[Computed tomography|CT]]
-| style="background:#F5F5F5;" + |
-* [[Lung volumes]] decreased
-* [[Vital capacity|FVC]] reduced
-* [[FEV1/FVC ratio]] <70%
-| style="background:#F5F5F5;" + |
-* Tissue [[biopsy]]
-| style="background:#F5F5F5;" + |
-* [[Asthma]]
-* [[Eosinophilia]]
-* [[Rhinosinusitis]]
-|-
-| colspan="2" style="background:#DCDCDC;" align="center" + |[[Medication|'''Medication''']]
-| style="background:#DCDCDC;" align="center" + |[[ACE inhibitor|'''ACE inhibitors''']]<ref name="pmid1616218">{{cite journal |vauthors=Israili ZH, Hall WD |title=Cough and angioneurotic edema associated with angiotensin-converting enzyme inhibitor therapy. A review of the literature and pathophysiology |journal=Ann. Intern. Med. |volume=117 |issue=3 |pages=234–42 |year=1992 |pmid=1616218 |doi= |url=}}</ref><ref name="pmid7619667">{{cite journal| author=Wood R| title=Bronchospasm and cough as adverse reactions to the ACE inhibitors captopril, enalapril and lisinopril. A controlled retrospective cohort study. | journal=Br J Clin Pharmacol | year= 1995 | volume= 39 | issue= 3 | pages= 265-70 | pmid=7619667 | doi= | pmc=1365002 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7619667  }}</ref>
-| style="background:#F5F5F5;" align="center" + |Acute (depend on the medication)
-| style="background:#F5F5F5;" + |
-* From 2 weeks to 6 months
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + |−
-| style="background:#F5F5F5;" align="center" + | +
-| style="background:#F5F5F5;" + |
-* [[Wheeze|Wheezing]]
-| style="background:#F5F5F5;" + |
-* Not  indicated
-| style="background:#F5F5F5;" + |
-* No indicated
-| style="background:#F5F5F5;" + |
-* Normal function
-| style="background:#F5F5F5;" + |
-* Clinical diagnosis
-| style="background:#F5F5F5;" a+ |
-* Resolves in four to five days of stopping the medication
-*[[Angioedema]]
 |}
 </small></small>
@@ Line 1,142: / Line 735: @@
 ==Epidemiology and Demographics==
-Cough is one of the most common symptoms of children in outpatient department.
+*A [[cough]] is one of the most common [[presenting]] [[symptoms]] of [[children]] in the [[Outpatient|outpatient department]].
-*Ninety percent of acute cough in children is resolved within three weeks. The prevalence of Chronic Cough in children is approximately 5% to 10% in USA according to American Academy of Pediatrics.
+*Ninety percent of [[acute cough]]s in children are resolved within three weeks. The [[prevalence]] of [[Chronic cough|chronic cough]] in [[children]] is approximately 5% to 10% in the [[United States|USA]] according to the [[American Academy of Pediatrics]].
-*In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
 ===Age===
-*Cough is more commonly observed among children under 5 years of age.<ref name="pmid16428719">{{cite journal |vauthors=Chang AB, Glomb WB |title=Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=260S–283S |date=January 2006 |pmid=16428719 |doi=10.1378/chest.129.1_suppl.260S |url=}}</ref>
+*[[Cough]] is more commonly observed among [[children]] under 5 years of age.<ref name="pmid16428719">{{cite journal |vauthors=Chang AB, Glomb WB |title=Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=260S–283S |date=January 2006 |pmid=16428719 |doi=10.1378/chest.129.1_suppl.260S |url=}}</ref>
 ===Gender===
-*Boys are more commonly affected with cough than girls.<ref name="urlPrevalence of cough throughout childhood: A cohort study">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177485 |title=Prevalence of cough throughout childhood: A cohort study |format= |work= |accessdate=}}</ref>
+*Boys are more commonly affected with [[cough]] than girls.<ref name="urlPrevalence of cough throughout childhood: A cohort study">{{cite web |url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177485 |title=Prevalence of cough throughout childhood: A cohort study |format= |work= |accessdate=}}</ref>
 ===Race===
-*There are racial predilection for certain causes of Cough in children. Asthma is predominant in Blacks and American Indians or Alaska native while Cystic fibrosis, Wegener's granulomatosis are more frequently affecting Caucasians according to American Lung Association.
+*There are [[racial]] predispositions for certain causes of [[cough in children]]. [[Asthma]] is predominant in Blacks and American Indians or Alaska natives while [[Cystic fibrosis]], [[Wegener's granulomatosis]] more frequently affect Caucasians according to the [[American Lung Association]].
 ==Risk Factors==
+*Common [[risk factors]] in the [[development]] of a cough in children are:<ref name="pmid16428686">{{cite journal |vauthors=Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UBS, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM |title=Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=1S–23S |date=January 2006 |pmid=16428686 |pmc=3345522 |doi=10.1378/chest.129.1_suppl.1S |url=}}</ref><ref name="pmid4806394">{{cite journal |vauthors=Hope-Simpson RE, Miller DL |title=The definition of acute respiratory illnesses in general practice |journal=Postgrad Med J |volume=49 |issue=577 |pages=763–70 |date=November 1973 |pmid=4806394 |pmc=2495832 |doi=10.1136/pgmj.49.577.763 |url=}}</ref>
+**[[Preterm birth|Preterm]] birth and delivery by [[caesarian section]].
+**[[Respiratory Distress Syndrome]].
+**[[Congenital Heart Disease]].
+**Age less than 1 year.
+**[[Maternal]] [[Influenza vaccination]].
+**[[Malnutrition]].
+**[[Secondary|Secondary exposure]] to [[tobacco smoke]].
+**Air pollutants, [[Mold]], Inadequate [[ventilation]].
+**[[Immunodeficiency|Immunodeficiencies]].
+**Daycare attendance.
+**History of [[Atopy]].
+**Household pets.
+**Low [[socioeconomic]] status.
-*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
+==Natural History, Complications and Prognosis==
-==Natural History, Complications and Prognosis==
+*The majority of patients with [[acute cough]] have recovery within three weeks in 90% of cases. Some cases are progressed to [[subacute]] and [[chronic]] phases. [[Chronic cough]] lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.<ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
+*Early clinical features include frequent episodes of [[coughing]], [[runny nose]], [[sneezing]], [[low grade fever]], [[sore throat]], [[night sweats]], arching back, [[irritability]], [[failure to thrive]], [[fussiness]], and a choking sensation(foreign body impaction).<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref>
+*If left untreated, acute cough can cause following the [[Complications|complication]]s in children:<ref name="urlAcute cough in children">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056681/ |title=Acute cough in children |format= |work= |accessdate=}}</ref><ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
+**[[Otitis Media]]
+**[[Rash]]
+**[[Vomiting]]
+**[[Diarrhea]]
+**[[Bronchitis]]
+**[[Pneumonia]]
+*Chronic cough can progress to<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>-
+**Inability to sleep
+**[[Bronchospasm]]
+**[[Dizziness]]/ [[Syncope]]
+**[[Pneumothorax]]
+**[[Pneumomediastinum]]
+*[[Rib fracture]]
-*The majority of patients with [disease name] remain asymptomatic for [duration/years].
+*[[Prognosis]] is generally excellent and efficiently treatable in most of the etiology of cough in children.
-*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
-*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
-*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
-*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with [disease name] is approximately [#%].
 ==Diagnosis==
 ===Diagnostic Criteria===
+*Diagnosis of causes of a cough is made after a detailed history, [[Presenting symptom|presenting]] complaints and [[physical examination]] and laboratory findings in some cases. Cough can be classified according to:<ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
+**Duration.
+**Nature or quality of cough.
+**Etiology.
+**Anatomic location.
+**Grade.
-*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
+A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with [[vomiting]], food intake, [[posture]], presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.
+The following signs are alarming which need further emergent evaluation by the physician:
+:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
+:*[[Respiratory distress]]
+:*[[Stridor]]
+:*[[Toxic appearance]]
+:*[[Weight loss]]
-:*[criterion 1]
-:*[criterion 2]
-:*[criterion 3]
-:*[criterion 4]
 ===Symptoms===
-*[Disease name] is usually asymptomatic.
+*Cough may be associated with the following depending upon the cause:
-*Symptoms of [disease name] may include the following:
+:*[[Breathlessness]] and episodes of [[coughing]]
+:*[[Sneezing]]
+:*[[Fever]]
+:*[[Sore Throat]]
+:*[[Night Sweats]]
+:*[[Arching Back]]
+:*[[Irritability]]
+:*[[Failure to thrive]]
+:*[[Fussiness]]
+:*[[Choking sensation]]([[Foreign body]] impaction)
+:*[[Chills and Rigor]]
+:*[[Wheezing]]
+:*[[Headache]], [[myalgia]], [[fatigue]]
-:*[symptom 1]
-:*[symptom 2]
-:*[symptom 3]
-:*[symptom 4]
-:*[symptom 5]
-:*[symptom 6]
 ===Physical Examination===
-*Patients with [disease name] usually appear [general appearance].
+*Patients with [[cough]] are usually restless, [[irritable]], fussy. Children with severe [[respiratory distress]] usually are [[toxic]] and [[cyanotic]] in appearance. Presence of [[grunting]], nasal flaring, [[intercostal]] or [[subcostal]] [[retraction]] or [[accessory muscles of respiration|accessory muscle]] usage needs prompt evaluation.<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref><ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
 *Physical examination may be remarkable for:
-:*[finding 1]
+*Vital signs: Documentation according to patient's [[age]]
-:*[finding 2]
+**[[Blood pressure]]
-:*[finding 3]
+**[[Temperature]]
-:*[finding 4]
+**[[Respiratory rate]]
-:*[finding 5]
+**[[Heart rate]]
-:*[finding 6]
+**[[Growth]] charts and [[Human development (biology)|developmental]] milestones: [[weight]], [[height]], [[length]], occipitofrontal circumference
+*General Appearance: Level of [[consciousness]], [[Cyanosis]], Distressed or ill-appearing, hydration and nutritional status.
+*[[Skin]]: [[Turgor]], [[color]], texture, [[Rash|rashes]] or any other abnormal findings.
+*[[Lymphatics]]: [[Lymphadenopathy]], location, number and size, consistency, adherence to underlying structures.
+*[[Head]]: Size, shape, [[Fontanelle|fontanelle,]] overlapping [[suture]], [[scalp]], [[hair]].
+*[[Eyes]]: [[Lacrimation]], [[redness]], [[irritation]],  [[conjunctival injection]], [[Periorbital Edema|periorbital]] redness.
+*[[Ears]]: Position of ears along with [[external auditory canal]], [[tympanic membrane]] visualization.
+*[[Nose]]: Any deviation of [[nasal septum]], normal or hypertrophied inferior [[Nasal concha|turbinate]], [[nasal polyps]] and [[congestion]], [[nasal discharge]], tenderness over [[sinus]] point.
+*[[Mouth]] and [[throat]]: Look for any associated abnormality
+**[[Lips]]: [[Color]], [[Mucous membrane|mucosal]] abnormality and [[congenital]] lesions.
+**[[Buccal mucosa]]: Hydration, Color, Presence of anomaly.
+**[[Tongue]] and [[teeth]] and [[Gingiva|gum]]: Developmental anomaly, Color, [[papillae]].
+**[[Palate]]: [[Anomaly]], arch.
+**[[Tonsils]]: Color, size, any [[membrane]], [[calcification]] and exudates.
+**Posterior pharyngeal wall: Color, appearance.
+**[[Gag reflex]]: Intact or not.
+*[[Neck]]: [[Thyroid]], [[trachea]] position and examination, any [[cystic]] or [[nodular]] masses, presence of [[nuchal rigidity]].
+*[[Respiratory system|Respiratory]]:
+**[[Inspection (medicine)|Inspection]]: Breathing pattern (abdominal and periodic), respiratory rate, accessory muscle usage, chest wall shape.
+**[[Auscultation]]: breath sound symmetry, [[vesicular]], [[bronchial]], [[rales]], [[rhonchi]], wheezes, [[stridor]].
+**[[Percussion]]: [[resonance]], hyper resonance and dull.
+**[[Palpation]]: [[trachea]] position, [[tactile fremitus]].
+*[[Cardiovascular]]: [[rhythm]], [[heart murmur|murmur]], any radiation of sound, [[pulse]] in both extremities.
+*[[Gastrointestinal tract|Gastrointestinal]]: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses or rebound guarding.
+*[[Musculoskeletal system|Musculoskeletal]]: Aching back, [[scoliosis]], [[lordosis]], [[kyphoscoliosis]], swelling and tenderness in any muscles, joint, [[clubbing]], [[edema]], deformity of extremities, [[gait]] and [[posture]], any sign for [[hip dysplasia]].
+*[[CNS]]: [[Primitive reflexes|Primitive reflex,]] superficial and deep [[tendon reflex]], strength and tone of muscles, [[Cranial nerves|cranial nerve]] examination.
+*[[Genitourinary system|Genitourinary]]: Presence of [[external genitalia]] deformity , [[hydrocele]], [[cryptorchidism]] or [[hernia]].
 ===Laboratory Findings===
-*There are no specific laboratory findings associated with [disease name].
+*There are no specific [[Laboratory findings template|laboratory findings]] associated with cough. [[Laboratory test]]s are done to differentiate the causes of cough in children<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>.
+*[[Complete blood count|Complete Blood Count]]
-*A  [positive/negative] [test name] is diagnostic of [disease name].
+*[[Arterial blood gases|Arterial blood gas analysis]]
-*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
+*[[Culture medium|Culture]] of nasopharyngeal swab and broncho alveolar lavage
-*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
+*[[Gross examination|Gross]] and [[Microscopic examination|microscopic]] analysis and [[Sputum culture|culture of sputum]]
+*[[AFB stain|AFB]] testing and [[tuberculosis]] screening
+*[[Allergy]] test
+*Serum [[Immunoglobulins]], [[autoantibodies]]
+*[[Sweat test]]
+*Exhaled [[nitric oxide]] test
+*[[Esophageal|Esophagea]]<nowiki/>l [[pH]]
+*Serology for Pertusis, CMV, Chlamydia, HIV.
 ===Electrocardiogram===
-There are no ECG findings associated with [disease name].
+An [[The electrocardiogram|ECG]] may not be helpful in the diagnosis of [[congenital heart disease]], [[myocarditis]], [[valvular heart disease]], in children.
-OR
-An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 ===X-ray===
-There are no x-ray findings associated with [disease name].
+Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: [[Pneumonia]], [[Croup]], [[Bronchitis]], [[Epiglottitis]], [[Foreign body]] impaction etc. [[X-rays|X-ray]] of [[Paranasal sinus|paranasal sinuses]] helps in diagnosis of [[sinusitis]], deviated nasal septum.
-OR
-An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===Echocardiography or Ultrasound===
-There are no echocardiography/ultrasound findings associated with [disease name].
+[[Echocardiography]]/[[ultrasound]]  may be helpful in the diagnosis of causes of [[cough in children]]. [[Echocardiography|Echocardiographic]] findings aide in the diagnosis of [[congenital heart disease]], whereas USG findings can help in evaluating complications like [[peritonsillar abscess]], [[retropharyngeal abscess]] promptly.
-OR
-Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===CT scan===
-There are no CT scan findings associated with [disease name].
+The [[High Resolution CT|High resolution CT]] is used for diagnosing causes of [[chronic cough]] in children such as [[bronchiectasis]]. Sometimes it helps in identifying [[Congenital heart disease|congenital heart]] and [[Lung|lung anomalie]]<nowiki/>s.
-OR
-[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===MRI===
-There are no MRI findings associated with [disease name].
+A [[Chest]] [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of the dynamic function of airways disease.<ref name="pmid26342643">{{cite journal |vauthors=Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH |title=Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging |journal=Pediatr Radiol |volume=45 |issue=13 |pages=1901–15 |date=December 2015 |pmid=26342643 |pmc=4666905 |doi=10.1007/s00247-015-3420-y |url=}}</ref>. MRI can provide detailed findings of [[perfusion]], [[ventilation]] mechanism of [[lungs]] and [[diaphragm]]. It can show oxygen enhancement, congenital anomalies too.
-OR
-[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
-OR
-There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 ===Other Imaging Findings===
-There are no other imaging findings associated with [disease name].
+Other [[imaging]] techniques are used to evaluate causes of [[cough in children]].
-OR
+*Flexible [[Bronchoscopy]]
+*[[Barium]] esophagram.
+*[[Angiography]]
-[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
+===Other Diagnostic Studies===
-===Other Diagnostic Studies===
+Other investigations done to rule out [[differential diagnosis]] of [[cough in children]] are:
-*[Disease name] may also be diagnosed using [diagnostic study name].
+*[[Spirometry]] for evaluating [[Pulmonary function test|pulmonary function test.]]
-*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
+*[[Bronchodilators|Bronchodilator]] [[Provocation study|provocatio]]<nowiki/>n test.
+*Ciliary function test.
+*[[Genetic analysis]] for [[Cystic fibrosis transmembrane conductance regulator|CFTR]] [[mutation]], [[Primary ciliary dyskinesia]] etc.
+*Video [[fluoroscopic]] or [[Endoscopic|endoscopic swallow]] evaluation.
+*Environmental assessment.
 ==Treatment==
 ===Medical Therapy===
-*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
-*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
-*[Medical therapy 1] acts by [mechanism of action 1].
-*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
+*The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in the following sequences:<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |pmc=6372369 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref><ref name="pmid23115499">{{cite journal |vauthors=Goldman RD |title=Treating cough and cold: Guidance for caregivers of children and youth |journal=Paediatr Child Health |volume=16 |issue=9 |pages=564–9 |date=November 2011 |pmid=23115499 |pmc=3223897 |doi=10.1093/pch/16.9.564 |url=}}</ref><ref name="urlGuidelines for Evaluating Chronic Cough in Pediatrics CHEST">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(15)52858-4/fulltext#seccestitle90 |title=Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST |format= |work= |accessdate=}}</ref><ref name="pmid30828592">{{cite journal |vauthors=Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ |title=Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough |journal=Glob Pediatr Health |volume=6 |issue= |pages=2333794X19831296 |date=2019 |pmid=30828592 |pmc=6390215 |doi=10.1177/2333794X19831296 |url=}}</ref>
+*Identification of etiology of cough and emergently manage the emergency condition such as [[foreign body impaction]], severe respiratory distress, [[apnea]] with maintenance of airways, breathing, circulation.
+*General measures with adequate hydration, nasal airway clearance with normal saline, reducing fever with [[antipyretics]] are done to give comfort to the child.
+*Medical management:
+**[[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
+**[[Bronchodilators]] ([[Ipratropium bromide]], [[Albuterol]], [[Salmeterol]], [[Salbutamol]]), [[Antibiotic]] ([[Amoxicillin-Clavulanate|Amoxicillin/Clavulanate]], [[Cephalosporins]], [[Respiratory]] [[fluoroquinolones]], [[Antiviral]], [[Antifungal]], [[Antiparasitic]]) are used according to [[Evidence-based medicine|evidence-based management]] of particular causes of cough in children.
 ===Surgery===
-*Surgery is the mainstay of therapy for [disease name].
+*Some [[surgical procedure]]s are performed for patients with [[Tonsillitis]], [[Adenoid hypertrophy|adenoid hypertroph]]<nowiki/>y, severe cases of [[laryngomalacia]], [[tracheoesophageal fistula]], [[congenital heart disease]], [[complications]] of any disease or trauma in [[ear]], [[nose]], [[Paranasal sinus|sinuses]], [[pharynx]], [[larynx]], [[trachea]], [[bronchus]], [[Lung|lungs]], and [[ribs]].
-*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
-*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
 ===Prevention===
-*There are no primary preventive measures available for [disease name].
+*Effective measures for the [[primary prevention]] of cough include:
+**Caregivers should be given [[health education]] on pros and cons of [[vaccination]], alarming features of cough.
-*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
+**Physical [[hygiene]] including [[airways]] of an infant or a child should be maintained to prevent complications.
+**Head should be raised to prevent irritations in [[throat]].
-*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
+**Humidified air will help clearing the sputum easily.
+**Adequate [[hydration]] to prevent formation of [[dry sputum]].
+**Avoidance of triggers in case of [[atopic]] patient.
+**[[Nutritional]] balance should be maintained for rebooting the [[immunity]].
 ==References==
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 [[Category:Pediatrics]]
+[[Category:Primary care]]
+[[Category:Up-To-Date]]