🦠 Acute Cough (<4 weeks)
• Viral URI/bronchitis: most common, self-limited 2-3 weeks
• Croup: ages 3m-3y, barky cough, stridor, worse at night
• Pertussis: paroxysms, whoop, post-tussive vomiting, lymphocytosis
• Bacterial pneumonia: fever, focal findings
⚠️ Red Flags
• Choking episode → foreign body aspiration (10-25% radiopaque)
• Whoop, paroxysms, post-tussive vomiting → pertussis
• Nocturnal worsening, exercise-induced → asthma
• Hemoptysis, weight loss, night sweats, dysphagia
🩺 Chronic Cough (>4 weeks)
• Asthma: most common cause of recurrent cough in children
• Protracted bacterial bronchitis: wet cough, responds to antibiotics
• Post-infectious cough: up to 8 weeks after URI
• UACS (postnasal drip) with sinusitis/allergic rhinitis
• Habit cough: awake only, disappears with sleep/distraction
📋 Diagnostic Keys
• Pertussis: PCR first 3 weeks, culture gold standard, WBC with lymphocytosis
• Asthma: nocturnal cough, triggered by colds/exercise/cold air, bronchodilator response
• Croup: clinical diagnosis; imaging only if atypical
• Foreign body: bronchoscopy if high suspicion (even if CXR normal)
📌 Decision strategy: Duration guides workup. Acute + stridor → croup. Paroxysms with whoop → pertussis. Choking history → bronchoscopy. Chronic cough → asthma first, but consider protracted bacterial bronchitis and foreign body.