Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Acute deterioration within chronic cough
Haemoptysis threatening the airway, hypoxaemia, severe respiratory distress, suspected inhaled foreign body, sepsis or weight-losing tuberculosis requires urgent assessment despite the cough's duration.
Action: Stabilise airway, breathing and circulation, give oxygen, isolate appropriately when transmissible infection is possible and involve paediatrics. Use the foreign-body, haemoptysis, sepsis or TB pathway immediately; take targeted cultures and imaging without delaying emergency treatment. Do not attribute new physiological compromise to a benign chronic or habit cough.
Synopsis
Assess cough persisting beyond the expected acute period by wet or dry quality, onset, age and red flags; identify foreign body, suppurative lung disease and aspiration; use targeted radiography and spirometry; and avoid indiscriminate antibiotics, acid suppression or asthma treatment.
Definitions vary: paediatric respiratory pathways commonly investigate daily cough beyond 4 weeks, while traditional BTS terminology calls more than 8 weeks chronic. Use trajectory and red flags rather than waiting for a label.
First branch is wet versus dry. A wet cough indicates airway secretion even when a child swallows sputum; parent-recorded audio or video can improve description.
First-line assessment is detailed history, examination, chest radiograph and spirometry with bronchodilator response when age and ability permit.
Key red flags
Daily wet cough is abnormal and suggests endobronchial infection, bronchiectasis, aspiration or impaired clearance.
Investigation priorities
01
First-line: chest radiographFirst stepFirst line
Identify focal collapse, infection, gross structural disease or cardiac enlargement.
02
First-line when able: spirometry with reversibilityFirst line
Assess obstructive physiology and variable bronchodilator response.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.