A Multicenter Study on Chronic Cough in Children

Chang, Anne B.; Robertson, Colin F.; Asperen, Peter P Van; Glasgow, Nicholas; Mellis, Craig; Masters, Ian Brent; Teoh, Laurel; Tjhung, Irene; Morris, Peter S.; Petsky, Helen; Willis, Carol; Landau, Lou

doi:10.1378/chest.11-2725

Cited by 179 publications

(124 citation statements)

References 43 publications

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“…In the majority of cases, cough is self-limiting, but its persistence could become annoying and could impair both quality of life and social activities 1. The management of both acute and chronic cough requires a systematic and comprehensive approach.…”

Section: Introductionmentioning

confidence: 99%

“…The identification of the cause of cough is crucial in order to determine the right treatment. Although several tests can be done for investigating chronic cough and defining the correct approach to speed up diagnosis and treatment, misuse of some tests (i.e., spirometry, chest radiography, head–neck computed tomography, allergic tests) may increase costs and delay both the diagnosis and the approach to the appropriate therapy 1,14,15. Moreover, pediatric evaluations can be compromised by parental perceptions: parents often exaggerate symptoms and/or require prescription of specific drugs, such as antibiotics, commonly regarded as the only effective therapeutic option 16,17…”

Section: Introductionmentioning

confidence: 99%

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Survey on attitudes of Italian pediatricians toward cough

Zanasi

Morcaldi

Cazzato³

et al. 2017

CEOR

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ContextChildren’s cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions – sometimes substantially.ObjectiveThe objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life.MethodsA specific questionnaire consisting of 18 questions was prepared. The questionnaire was completed by 300 pediatricians (all members of PAIDOSS: Italian National Observatory on Health of Childhood and Adolescence) who represented ~300,000 children.ResultsA vast majority of children have cough throughout the year (99.3% of respondents have cough during autumn/winter and 64.7% in spring/summer). Allergic disease is the most frequent suspected cause of chronic cough in children (53%), and this is supported by the high demand for consultations: 73% seek the opinion of allergologists, 62% of otorhinolaryngologists and only 33% of pulmonologists. The majority of pediatricians (92%) reported that they prescribe therapy in acute cough regardless of cough guidelines. Moreover, the survey pointed out the abuse of aerosol therapy (26% in acute cough and 38% in chronic cough) and of antibiotics prescription (22% in acute cough and 42% in chronic cough).ConclusionOur survey suggests that some Italian pediatricians’ therapeutic attitudes should be substantially improved in order to achieve better management of cough in children and to minimize the burden of cough.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survey on attitudes of Italian pediatricians toward cough

Zanasi

Morcaldi

Cazzato³

et al. 2017

CEOR

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“…Australian data suggest cough burden is independent of age and aetiology, but dependent on clinical setting. 29 In Australia, there are clear risk and burden distinctions between children from urban and remote areas and between Indigenous and non-Indigenous children. 59 Indigenous children in urban areas have received much less attention than those in remote centres.…”

Section: Discussionmentioning

confidence: 99%

“…Although contamination of the control group is possible, based on a multicentre RCT conducted in five major Australian cities, 29 it is unlikely that a child in standard care will receive treatment similar to the intervention arm. In another of our studies, 52 just 27% of children sought further medical advice for cough in the 4 weeks following presentation to an ED for an illness with cough as a symptom (unpublished data).…”

Section: Discussionmentioning

confidence: 99%

“…Indigenous children (10/34; 29.4%) were more likely to have bronchiectasis than non-Indigenous children (6.7%; 21/312; OR=5.78, 95% CI 2.15 to 14.5; p<0.001). 29 Despite the high burden of ARI, there are little published data on interventions for acute and chronic cough, especially for urban and regional Indigenous children. An ARI sometimes unmasks a previously unrecognised chronic respiratory illness, which is a major problem in Indigenous Australians, but one that receives limited attention.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

et al. 2017

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IntroductionAcute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care.Methods and analysisA multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged <15 years will be enrolled and followed weekly for 8 weeks after presenting with an ARI with cough. 214 children from this cohort with persistent cough at day 28 will be randomised to either early initiation of a cough management algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (<6 and ≥6 weeks). Demographic details, risk factors, clinical histories, examination findings, cost-of-illness data, an anterior nasal swab and parent and child exhaled carbon monoxide levels (when age appropriate) are collected at enrolment. Weekly contacts will collect cough status and cost-of-illness data. Additional nasal swabs are collected at days 28 and 56. The primary outcome is time-to-cough resolution. Secondary outcomes include direct and indirect costs of illness and the predictors of chronic cough postpresentation.Ethics and disseminationThe Children's Health Queensland (HREC/15/QRCH/15) and the Queensland University of Technology University (1500000132) Research Ethics Committees have approved the study. The study will inform best-practice management of cough in children.Trial registration numberACTRN12615000132549.

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Antibiotics for prolonged wet cough in children

Marchant

Petsky

Morris

et al. 2018

Cochrane Database of Systematic Reviews

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Evidence suggests antibiotics are efficacious for the treatment of children with chronic wet cough (greater than four weeks) with an NNTB of three. However, antibiotics have adverse effects and this review reported only uncertainty as to the risk of increased adverse effects when they were used in this setting. The inclusion of a more robust study strengthened the previous Cochrane review and its results.

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A Multicenter Study on Chronic Cough in Children

Cited by 179 publications

References 43 publications

Survey on attitudes of Italian pediatricians toward cough

Survey on attitudes of Italian pediatricians toward cough

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

Antibiotics for prolonged wet cough in children

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