Chronic cough and wheeze in children: do they all have asthma?

Abstract

In the experience of both authors, children referred for investigation of a chronic productive cough often do not fit conventional diagnostic categories. The aim of this study was to answer two questions: 1) do such diagnostic orphans exist? and, 2) if so, can they be classified in a clinically useful manner?Eighty one previously undiagnosed children referred with a history of more than 3 months productive or rattly cough were studied prospectively. Investigations consisted of a detailed history, physical examination, and an extensive set of clinical investigations. Sixty randomly selected asthmatic children served as demographic controls.Children fell into three groups: 23 had newly diagnosed conditions, such as cystic fibrosis, or were indistinguishable from asthma; 24 had a history of major medical interventions (cardiac surgery, chemotherapy, tracheo-oesophageal fistula repair); 34 had a history of significant early respiratory tract infections, usually combined with poor social conditions. The latter group differed significantly from asthmatic controls in a wide range of demographic and clinical comparisons. Native American children were overrepresentedThe results of this study suggest that early respiratory insults (whether viral or medical) can induce self-perpetuating inflammation, manifesting as a chronic productive cough and intermittent wheeze. The associations between poverty and infant chest infections or early invasive medical treatment with subsequent chronic respiratory disease are clearly definable and probably justify diagnostic terms distinct from asthma, particularly for use in epidemiological studies.

Causal Relationship of Chronic Cough with Asthma and Upper Airway Problems in School Going Children Aged 8-12 Years

“…More remarkable results were found by M Seear in a prospective review of 81 children with chronic cough, where none had asthma on final diagnosis. [14] Similar conclusion was drawn by Thomson et al in a retrospective study in 2002. [15] In other studies, when airway profiles have been examined in children with isolated chronic cough, very few children with airway inflammation were found to be consistent with asthma.…”

Recommendations for the assessment and management of cough in children

“…Juvenile chronic bronchitis with persistent endobronchial infection (recently labelled persistent bacterial bronchitis) has been described for many decades 104 – 112. Children have chronic or recurrent cough with sputum production.…”

Viral Infections and Childhood Asthma

“…The pathogenesis of this syndrome is not well understood. A small caliber of the airways associated with unusual lung mechanics might be the most important determining factor responsible for recurrent or protracted bronchus obstruction in this age group, even after trivial respiratory insults, such as mild viral infections (3). There might also be a genetically determined premorbid abnormal lung function.…”

“…There might also be a genetically determined premorbid abnormal lung function. In the absence of protective immunological memory, mild viral infections might induce more or less severe inflammation of the airways during initial viral infections, possibly accompanied by prolonged periods of hyperreactivity (3). Finally, maternal smoking during pregnancy can also play a role (4).…”