La tosse (o le tossi)

Cough is a frequent symptom, ranging from the simple, irritatingly cough associated with the common cold to the catarrhal cough of sinusitis and to the prolonged afebrile non productive cough caused by intracellular pathogens such as Mycoplasma and Chlamydia. Cases of particularly troublesome, recurrent, “untreatable”, nonspecific cough are also commonly seen by paediatricians. Such cases have increasingly been diagnosed as having asthma (cough-variant asthma), but epidemiological and clinical evidence suggests that cough is unlikely to be the only manifestation of asthma. This kind of cough is likely to be related to an increase of cough receptor sensitivity (CRH). The pathways of the reflex for cough and bronchoconstriction are distinctly different. Children with cough receptor hypersensitivity usually start coughing at bedtime and cough is typically unresponsive to treatment, and getting worse with time: in these children an increase of receptor sensitivity is probably due to cough itself. Chronic cough (lasting months and particularly if productive productive) should never be overlooked and requires a thorough diagnostic evaluation including sweat test and high resolution CT scan. Psychogenic cough is typical of school age children, it is stereotyped and stops, as a rule, as the child gets asleep.