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Analysis

GPs’ role in managing children and adolescents with ‘wet cough’


Emma Kennedy


11/03/2024 4:34:40 PM

The presentation requires specific management to avoid chronic lung disease consequences later in life, writes Associate Professor Emma Kennedy.

GP using stethoscope on young child.
It is not uncommon for young patients to present with a persistent wet cough.

As a working GP of 25 years, I can’t tell you how many parents have brought in a child with a nasty cough for me to look at.
 
But while this kind of presentation is not uncommon, particularly where I’m based in the NT, reports suggest parents often don’t say how long these symptoms have persisted for, nor how often they occur, unless prompted by a health professional.
 
And even when they do, many parents feel unheard when relaying the story of their child’s persistent cough, especially when the practitioner instead suggests the origin is viral and there is no need for specific antibiotic treatment.
 
Of course, antibiotic stewardship is a key element of being a GP, and we can’t just hand out a prescription to simply ease the concerns of a worried parent. But as health professionals, we also need to proactively consider the history of the cough in order to provide most appropriate treatment and help avoid future chronic lung disease.
 
GPs are often perfectly placed to ensure timely management of children and adults who present with a persistent wet cough, and taking a history to explore its features and persistence is a critical first step.
 
I’ve found parents are typically grateful when their child’s chronic cough is effectively managed, as it can significantly impair their quality-of-life.
 
A recent article I contributed to in the MJA outlines evidence and important features for diagnosis and treatment of the wet or productive cough, but the most significant message to recognise those at risk through the features of presentation and instigating the next steps to diagnosis and management.
 
While there are high fidelity investigations used for diagnosis that may not be immediately accessible to all communities, like the MDCT scans with HRCT reconstruction, GPs talk with the patient and their family reinforce the importance of follow-up, and set up accessible investigations and referral.
 
We frequently hear from parents and carers of young people with chronic cough that their symptoms had not been recognised, even though the severity should have triggered further inquiry and more timely treatment.
 
This message is important for primary healthcare, where the rigor of the consultation can make a difference to the prevention of illness.
 
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Dr Alan Robert McLean   15/03/2024 5:21:10 AM

Our clinic in WA recently participated in research on Wet Cough. It seems roughly that some the criticism from specialists which GPs previously received for over prescribing antibiotics, is now being quietly 'taken back'. Now it seems we are being criticised for NOT prescribing! I usually offer antibiotics if a patient has had infective respiratory symptoms for 10 days and inform them that althought they may not need the drugs to stay alive, the treament may shorten the course of their cough. It seems that I am still in the "bad prescriber" group as I have not waited 28 days. There is a 'Holier than Thou' attitude toward GP antibiotic use from specialist groups.
I believe many specialists would not wait 28 days before getting antibiotics.