Chronic and recurrent cough, sinusitis and asthma. Much ado about nothing

Abstract

Respiratory infections are the main causes of chronic or recurrent cough in children. Children present 3.8-8 infective episodes per year with cough lasting, on average, 1-3 wk and 10% will still have cough after 4 wk. There is evidence of over-treatment of cough with antibiotics, anti-asthmatic drugs (in Italy) and symptomatic treatments, all with insufficient evidence of efficacy. The relation between sinusitis, asthma and isolated cough is possibly overemphasized. Cough is a symptom of sinusitis, but one can rarely expect isolated persistent or recurrent cough as the only symptom. The issue of chronic cough as the only sign of asthma has been extensively investigated. Recent literature established that the majority of children with isolated cough do not have asthma in terms of both absence of signs of typical asthma inflammation and response to steroid treatment. This unconfirmed hypothesis has unfortunately often resulted in a misunderstood use of inhaled steroids as 'symptomatic' treatment. Our aim should be to avoid unnecessary medicalization and lessen anxiety not by simply prescribing, but by spending time in evaluating patients and explaining to parents what are mostly physiological events, which should resolve spontaneously over time.