Chest
Volume 129, Issue 5, May 2006, Pages 1132-1141
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Original Research: Cough
Evaluation and Outcome of Young Children With Chronic Cough

https://doi.org/10.1378/chest.129.5.1132Get rights and content

Objective

To evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children with a history of > 3 weeks of cough and to describe the etiology of chronic cough in this cohort.

Methods

A prospective cohort study of children referred to a tertiary hospital with a history of > 3 weeks of cough between June 2002 and June 2004. All included children followed a pathway of investigation (including flexible bronchoscopy and evaluation of airway cytology via BAL) until diagnosis was made and/or their cough resolved.

Results

In our cohort of 108 young children (median age 2.6 years), the majority had wet cough (n = 96; 89%), and BAL fluid samples obtained during bronchoscopy led to a diagnosis in 45.4% (n = 49). The most common final diagnosis was protracted bacterial bronchitis (n = 43; 39.8%). These patients had neutrophil levels on BAL samples that were significantly higher than those in other diagnostic groups (p < 0.0001). Asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS), which are common causes of chronic cough in adults, were found in < 10% of the cohort (n = 10).

Conclusions

The adult-based anatomic pathway, which involves the investigation and treatment of patients with asthma, GERD, and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults.

Section snippets

Subjects

Any child (ie, age < 18 years) with chronic cough of unknown etiology who was referred to the pediatric respiratory practice at our university hospital between June 2002 and June 2004 was invited to participate. Chronic cough was defined as a cough of > 3 weeks duration.11, 14 The children attended an initial visit, which included a detailed medical history and physical examination using a standardized data collection sheet. The history included the duration and character of the cough, family

Results

The median age of the 108 young children studied (51 male, 57 female) was 2.6 years (IQR, 1.2 to 6.9 years). These children were recruited from 114 who had been invited to participate. The main reason for nonparticipation was an unwillingness to complete the cough diaries and/or further investigations. The prestudy diagnoses were asthma (n = 54; 50%), no preexisting diagnosis (n = 34; 31.5%), and bronchitis (n = 2; 2%), and patients were referred from pediatricians (n = 56; 52%) and general

Discussion

This is the first study that has prospectively evaluated young children using a modified protocol based on the protocol of Irwin et al11 for chronic cough in adults. We have found that the diagnostic categories for chronic cough in children are heterogeneous and that the most common diagnosis was PBB, with the three most common diagnoses of chronic cough in adults (ie, asthma, UACS, or GERD)14 being found in only 9% of young children.

Adult studies30 have described that a systematic evaluation

ACKNOWLEDGMENT

The authors sincerely thank the children and their parents who so willingly participated in the study; and Dr. Paul Francis, Dr. Claire Wainwright, Professor Alan Isles, and Dr. Nigel Dore for their assistance with patient recruitment.

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      In one cohort, the common causes of cough in adults: asthma, gastroesophageal reflux disease, and upper airway cough syndrome (postnasal drip) together make up less than 10% of the underlying reason for cough in children.31 The routine use of antireflux medication is not recommended without specific signs or symptoms that suggest reflux.31,33 Such symptoms should be recurrent regurgitation, dystonic neck posturing in infants, or heartburn/epigastric pain in older children.35

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    Dr. Marchant is supported by the Royal Children's Hospital Foundation, Brisbane. Dr. Chang is funded by a Practitioner Fellowship from the National Health and Medical Research Council, Australia.

    No authors have any known conflicts of interest to disclose.

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