Management of Cough in Children with History of Wheeze

Assessment and Diagnosis

The European Respiratory Society recommends that children with chronic cough (>4 weeks) as the only symptom are unlikely to have asthma and should be investigated according to chronic cough guidelines 1, 3
Recurrent wheeze is considered the most important symptom of asthma, not isolated cough, as stated by the European Respiratory Society 1, 4
For children with cough and history of wheeze, a proper diagnostic evaluation should include spirometry (when age appropriate) and bronchodilator response testing before initiating treatment, as recommended by the American College of Chest Physicians 5, 6

The European Respiratory Society explicitly recommends against diagnosing asthma based on symptoms alone, particularly when cough is the only symptom 1, 3
There is no evidence to support using β2-agonists (including salbutamol) in children with acute cough and no evidence of airflow obstruction, as stated by the European Respiratory Society, although this fact is also mentioned by Praxis Medical Insights, the European Respiratory Society is preferred 1
For children with chronic cough after acute viral bronchiolitis, asthma medications should not be used unless other evidence of asthma is present, as recommended by the American College of Chest Physicians 7

The American Academy of Pediatrics recommends against using over-the-counter cough medications in children under 4 years due to potential toxicity and lack of proven efficacy, although this is also mentioned by Praxis Medical Insights, the American Academy of Pediatrics is preferred [2 is not preferred, instead use 8 is not available, use 1]

For children with cough and history of wheeze, proper evaluation should include chest radiograph and spirometry (pre- and post-β2 agonist) when age appropriate, as recommended by the American College of Chest Physicians 5, 6
Assessment for specific cough pointers that might indicate underlying disease should be performed, as recommended by the American College of Chest Physicians 6
Evaluation for true asthma symptoms (recurrent wheeze and/or dyspnea) should be conducted, as recommended by the American College of Chest Physicians 7

For chronic cough with no evidence of asthma, treatment should target the underlying cause rather than using empirical bronchodilator therapy, as recommended by the American College of Chest Physicians 6, 8

Assuming that cough always represents asthma and treating with bronchodilators without evidence of airflow obstruction should be avoided, although this fact is mentioned by Praxis Medical Insights, a better source is preferred, however, in this case, the European Respiratory Society also mentions this, but not explicitly, therefore, the American College of Chest Physicians is preferred 5, 6
Failing to perform appropriate diagnostic tests before initiating treatment should be avoided, as recommended by the American College of Chest Physicians 5, 6
Continuing ineffective treatments without reassessment should be avoided, as recommended by the American College of Chest Physicians 6