Chronic Cough (Daily Cough for Greater Than 4 Weeks) - Medicine - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

• Lyell McEwin Hospital (08) 8182 9000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Regional Health Networks 

Eyre and Far North Local Health Network

• Port Lincoln Hospital (08) 8682 5831
  

Flinders and Upper North Local Health Network

• Port Augusta Hospital (08) 8668 7500

Limestone Coast Local Health Network

• Mount Gambier District Hospital (08) 8721 1200

Exclusions

• refer to cardiology for chronic cough presentations with the following features:
  • abnormal heart sounds
  • abnormal/irregular pulse
  • murmur
  • abnormal electrocardiogram (ECG)
• exposure to contacts with confirmed tuberculosis (TB), refer to SA Tuberculosis services

Triage categories

Category 1 (appointment clinically indicated within 30 days)

• chronic cough present for greater than 4 weeks with concerning features:
  • colour change during coughing episode
  • dysphagia
  • feeding difficulties
  • finger and toe clubbing
  • night sweats
  • unintentional weight loss
  • unusual respiratory noises
  • vomiting associated with coughing episode

Category 2 (appointment clinically indicated within 90 days)

• recurrent bacterial pneumonia at least 2 episodes in 12 months
• refractory cough present for greater than 4 weeks despite first line management without concerning features
• protracted bacterial bronchitis not responding to empirical treatment

Category 3 (appointment clinically indicated within 365 days)

• nil

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

• past medical history, provide any relevant features as relating triage categories
• presenting symptoms including:
  • duration and frequency of episodes
  • triggers
  • concerning features
  • type of cough -  wet, honking, staccato, not present when sleeping, associated with vomiting
  • risk of exposure to tuberculosis (TB) or whooping cough
  • treatments trialled prior to referral and efficacy
• height and weight
• cardiac and respiratory examination findings

Additional information to assist triage categorisation

• family history of respiratory disease
• chest x-ray
• body mass index (BMI) if child is aged ≥ 16 years
• growth chart trends
• pathology -  sputum microscopy, culture, and sensitivities (M/C/S) if relevant
• pulmonary function test (children older than 6 years)
• relevant diagnostic and imaging reports including location of company and accession number

Clinical management advice

Chronic cough is defined as daily cough present for greater than 4 weeks.

Likely causes differ by age. For infants and younger children, it is important to consider general growth and developmental trajectory, as these may be signs of a more serious underlying illness or warrant more urgent management.

To determine the most suitable treatment, it's essential to identify the underlying cause of the cough, whether it falls into the acute, protracted acute, or chronic category. Most common reasons for a chronic cough can include:

• allergies or allergic rhinitis
• asthma
• environmental factors -  exposure to tobacco smoke, mould from air conditioners, proximity to industry/farm
• foreign body
• psychogenic cough
• respiratory infection
• undiagnosed respiratory disease
• viral illnesses
• protracted bacterial bronchitis

For children in their first few years of childcare or school, it is common and expected to have up to 12 viral infections per year. Primary care providers play an important role in providing reassurance to parents where no other clinical concerns are present, as well as minimising unnecessary of antibiotics for viral illnesses.

Clinical resources

• European Respiratory Society - ERS guidelines on the diagnosis and treatment of chronic cough in adults and children
• Royal Children’s Hospital Melbourne Clinical Practice Guideline - Cough
• Therapeutic Guidelines – Cough in children
• Royal Children’s Hospital Melbourne - Basic Paediatric ECG interpretation
• SA Health – Tuberculosis (TB) - including symptoms, treatment and prevention
• Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia

Consumer resources

• Royal Children’s Hospital Melbourne Fact Sheet - Cough

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

• full name, including aliases
• date of birth
• residential and postal address
• telephone contact number/s – home, mobile and alternative
• Medicare number, where eligible
• name of the parent or caregiver, if appropriate
• preferred language and interpreter requirements
• identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

• impact on employment
• impact on education
• impact on home
• impact on activities of daily living
• impact on ability to care for others
• impact on personal frailty or safety
• identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

• Willingness to have surgery, where surgery is a likely intervention.
• Choice to be treated as a public or private patient.
• Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The General Practitioners role in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the General Practitioner once the transfer of care has occurred.