AAAAI: How to Differentiate Causes of Chronic Cough in Pediatric Patients

In an interview with Pharmacy Times, Meera Gupta, MD, FAAAAI, associate professor of pediatrics at Baylor College of Medicine and Texas Children's Hospital in Houston, Texas, discussed the clinical considerations outlined in her session, “Differential Diagnosis of Chronic Cough in a Child,” presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Annual Meeting in Philadelphia, Pennsylvania.

Gupta emphasized that chronic cough remains a common pediatric concern, affecting an estimated 2% to 22% of children, yet most cases stem from 4 primary etiologies: asthma, upper airway cough syndrome (including rhinitis), infections, and reflux.

Although these causes predominate across age groups, their frequency varies. In younger children, infections are more common, followed by asthma and rhinitis-related conditions, whereas asthma becomes the leading cause in older children. Gupta cautioned against reflexively pursuing extensive diagnostic testing, underscoring that a thorough history and physical examination remain the most valuable tools in distinguishing among causes. Key diagnostic clues include whether the cough is wet or dry, identifiable triggers, timing of onset, and response—or lack thereof—to prior therapies.

She also highlighted red flags that warrant broader evaluation, including hemoptysis, poor growth, weight loss, recurrent infections, or failure to respond to appropriate therapy. Such findings may indicate less common but more serious underlying conditions.

“If you're not taking your inhalers and using your spacers correctly, the medicine is not going to get to where it needs to go.” — Meera Gupta, MD, FAAAAI.

Regarding allergen exposure, Gupta noted that outside of asthma or allergic rhinitis, aeroallergens are rarely the primary drivers of chronic cough. Careful history-taking should guide decisions about allergy testing to avoid unnecessary interventions.

For pharmacists, Gupta emphasized the importance of reinforcing adherence, particularly because chronic cough management often involves prolonged empiric trials. Proper inhaler technique and spacer use are critical to therapeutic success.