Chronic cough in childhood: Approach to diagnosis and treatment

Parks, David P.; Ahrens, Richard C.; Humphries, C. Thomas; Weinberger, Miles

doi:10.1016/s0022-3476(89)80123-4

Cited by 39 publications

(22 citation statements)

References 20 publications

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“…[16][17][18][19] In addition, this approach is consistent with the observation that the most frequent presenting symptoms of asthma among children are cough (92%), wheeze (90%), and shortness of breath (83%). 33 Redline et al 16 recently reported that cough and breathing problems were more useful criteria than was wheezing. However, because wheeze is such a common stand-alone criterion in many surveys, we analyzed the value of wheeze as a stand-alone criterion and evaluated its effect in adding it to the abbreviated algorithm.…”

Section: E312mentioning

confidence: 99%

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

Galant¹

2004

PEDIATRICS

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ABSTRACT. Objective. Bronchial asthma, which affects ϳ5 million US children, is vastly underdiagnosed and treated, particularly among minorities and those of low socioeconomic status. Because current methods of detecting those at greatest risk of asthma in a multicultural setting appear inadequate, we assessed the validity and reliability of a new asthma questionnaire across 3 dominant cultures in Orange County, California (white, Hispanic, and Vietnamese).Methods. Children in grades 1, 3, and 5 and their families, in 3 different schools representative of these major ethnic groups, were randomly selected to participate in the validation process. Two schools with low socioeconomic status and dominant Hispanic or Vietnamese minorities were designated inner-city schools, whereas the third school was a suburban school with predominately white students. Participants completed a 7-question, 11-element questionnaire in their primary language, followed by an asthma evaluation (history, physical examination, and spirometry) by an asthma specialist (who was blinded with respect to the results of the questionnaire), at their respective schools. The physician then made a determination regarding the presence and severity (according to National Institutes of Health guidelines) of asthma. Several weeks later, the entire student body was asked to complete the questionnaire at home and return it to school for analysis. Validation of each item was evaluated for sensitivity, specificity, and positive and negative predictive values, and application of univariate analyses provided an estimated probability of an asthma diagnosis by the asthma specialist. A "bestfit" algorithm was determined with all 11 elements, if possible, and an abbreviated algorithm that selected the fewest-question combination that yielded the best asthma predictability was established. Reliability was established with the percent agreement between the 2 questionnaires and the statistic.Results. Of the 401 children/families who participated in the validation analysis, 45% were Hispanic, 22% white, 19% Vietnamese, and 15% other. The overall prevalence of asthma specialist-diagnosed asthma was 28%, with 65% of cases being graded as intermittent and 35% as persistent. Sixty-two percent of the children had not been previously diagnosed with asthma. There were no significant differences among cultures in sensitivity or specificity for any of the individual questions or the complete or abbreviated algorithms. The abbreviated algorithm with 3 questions, ie, question 1 (asthma in the past 2 years), question 4 (cough, chest tightness, trouble breathing, or wheezing with exercise), and question 6 (same symptoms in the morning or day in the past 4 weeks) yielded comparable sensitivity and specificity for the complete algorithm in all groups. The abbreviated algorithm had >86% predictability in detecting children with persistent asthma and 56% predictability in detecting children with intermittent asthma. Reliability was also excellent, with percent agreement usually > 80% ...

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Section: E312mentioning

confidence: 99%

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

Galant¹

2004

PEDIATRICS

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“…These studies may have led to a much more liberal application of the label of asthma to children with cough in the current era of asthma awareness [22]. Some studies have found, as this study did, that some children (although only a minority) presenting with chronic cough subsequently have wheezing [16, 20, 21, 23, 24]. P owell and P rimhak [15] reported a questionnaire study of 8–9‐yr‐old children in 1991 and 1993–1994.…”

Section: Discussionmentioning

confidence: 85%

Asthma survey items as predictors of respiratory problems in children 2 yrs later: a longitudinal study

Pattemore¹,

Lampe²,

Smith³

et al. 1999

Eur Respir J

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The study compared the ability of characteristics defined by an asthma survey (wheeze versus cough and asthma diagnosis versus no diagnosis) to predict later respiratory problems in a cohort of 108 schoolchildren who had reported either recent wheeze or recurrent cough in a 1987 asthma survey. The children recorded daily respiratory symptoms and peak flow from April 1989 until May 1990. The frequency and severity of lower respiratory symptom episodes and peak flow dips were compared in the wheeze and cough groups and in the diagnosed versus nondiagnosed children. The independent effects of initial wheeze, atopy, diagnosis and bronchial hyperresponsiveness (BHR) on the longitudinal outcome measures were assessed using multiple linear regression. Children with initial wheeze had more chronic symptoms and peak flow variability than those with cough alone, but wheeze had only a weak effect on frequency and severity of acute lower respiratory episodes. Children with both wheeze and atopy had more acute symptomatic episodes and more chronic symptoms than did the other children. Children with diagnosed asthma (versus no diagnosis) had significantly more frequent and severe lower respiratory exacerbations, more days symptomatic and greater peak flow variability. The predictive effects of diagnosis were independent of (and stronger than the effects of) wheeze, atopy and BHR, or combinations of these variables. The results suggest that among children who report respiratory symptoms, survey‐reported wheeze on its own is a weaker marker of significant respiratory disease than is a doctor′s diagnosis of asthma.

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“…[5], Meyer et Aitken [6] ; mais aussi supérieure à 4 semaines pour Parks et coll. [7]. D'autres comme Marguet et coll.…”

Section: Position Du Problème Toux Chroniques ? Toux Répétées ? Toux unclassified

Toux chronique de l’enfant

Pradal¹,

Retornaz

Poisson

2004

Revue des Maladies Respiratoires

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Chronic cough in childhood: Approach to diagnosis and treatment

Cited by 39 publications

References 20 publications

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

Predictive Value of a Cross-Cultural Asthma Case-Detection Tool in an Elementary School Population

Asthma survey items as predictors of respiratory problems in children 2 yrs later: a longitudinal study

Toux chronique de l’enfant

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