Localized tracheomalacia or bronchomalacia in children with intractable cough

Most coughs in children respond to diagnostic interventions or cough therapy. A cough that does not respond to any treatment is termed intractable cough. Since a cough can disrupt the quality of a child's life in school and at home, it has been hypothesized that some coughs may be psychological. Children who were referred for bronchoscopy, visual inspection of the breathing structures using a magnifying lens, were examined for anatomical abnormalities associated with retractable cough. Out of 2,059 children referred for bronchoscopy, 37 had a persistent cough. Of these, eight were diagnosed with a deep, brassy, nonproductive intractable cough. In seven male patients, an anatomical abnormality, tracheomalacia (softening of the cartilage of the trachea), was found. One boy without a physical abnormality had total collapse of the bronchus during coughing. All the boys reported coughing during sleep, which is not characteristic of psychogenic cough. It is hypothesized that contact of the membranous and cartilaginous portion of the airway during coughing created an irritation which lead to more coughing, ultimately creating a vicious cycle. It is possible however, that some cases having an anatomical abnormality also have a psychogenic component. Conversely, some patients with severe tracheomalacia do not have intractable cough. Bronchoscopy is recommended for children with deep, brassy, intractable cough. (Consumer Summary produced by Reliance Medical Information, Inc.)