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

Abstract

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.

Risk Factors for Chronic Cough in Young Children: A Cohort Study

“…However, the sensitivity analyses did not substantially change our findings. It is plausible that loss to follow-up would be more likely in children whose cough has stopped, particularly given the known burden of cough on families (8,35)and that parents in the study were informed at enrolment that if their child had persistent cough at day-28 they would be reviewed by a pediatrician over the following weeks (19).…”

“…This was a secondary analysis of data collected in a multi-center cohort study of children aged <15-years presenting to healthcare with cough. The full study protocol was published previously (19). Here, we included children aged <6-years and data from the first 4-weeks of follow-up.…”

The Incidence and Short-term Outcomes of Acute Respiratory Illness with Cough in Children from a Socioeconomically Disadvantaged Urban Community in Australia: A Community-Based Prospective Cohort Study

“…There is good evidence that cough management pathways in children with chronic cough are effective in improving clinical outcomes ( 48 ). An algorithm previously successfully evaluated in children with chronic cough ( 20 ) is now the subject of a clinical trial in children at the transitional phase from acute to chronic cough, including children from this study’s community ( 49 ). Given recurrent ARIs in early childhood, particularly LRTIs, are known precursors to chronic lung disease, further investigation and monitoring of children when they reach the “recurrent” threshold may be warranted.…”

Development of Machine Learning for Asthmatic and Healthy Voluntary Cough Sounds: A Proof of Concept Study

“…Cough in children is one of the commonest presentations to medical practitioners [1][2][3][4][5][6][7][8][9]. In children, cough is a manifestation of a broad spectrum of respiratory illnesses, ranging from rhinosinusitis, atopy, respiratory tract infection, and inhaled foreign body, to post viral/infectious cough [1,2,10].…”