Etiology analysis of nonspecific chronic cough in children of 5 years and younger

Chen, Xin; Peng, Wansheng; Wang, Lei

doi:10.1097/md.0000000000013910

Cited by 13 publications

(18 citation statements)

References 18 publications

(19 reference statements)

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“…CVA has been described as a mild variant of asthma, where children present with cough as the sole symptom, instead of all three key symptoms of cough, wheeze and dyspnoea [ 10 ]. The following features have been described as typical for CVA: a family or personal history of atopy, eosinophilic inflammation, increased bronchial reactivity including positive exercise tests, a positive response to bronchodilators and an increased risk for developing wheeze or typical asthma later [ 9 , 11 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated night cough in children: how does it differ from wheeze?

et al. 2020

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It has been postulated that some children with recurrent cough but no wheeze have a mild form of asthma (cough variant asthma), with similar risk factors and an increased risk of future wheeze.This longitudinal study compared risk factors for isolated night cough and for wheeze in the Leicester Respiratory Cohort in children aged 1, 4, 6 and 9 years and compared prognosis of children with isolated night cough, children with wheeze and asymptomatic children.We included 4101 children aged 1 year, 2854 aged 4 years, 2369 aged 6 years and 1688 aged 9 years. The prevalence of isolated night cough was 10% at age 1 year and 18% in older children. Prevalence of wheeze decreased from 35% at 1 year to 13% at 9 years. Although several risk factors were similar for cough and wheeze, day care, reflux and family history of bronchitis were more strongly associated with cough, and male sex and family history of asthma with wheeze. Over one-third of preschool children with cough continued to cough at school age, but their risk of developing wheeze was similar to that of children who were asymptomatic at earlier surveys. Wheeze tracked more strongly throughout childhood than cough.In conclusion, our study showed that only some risk factors for cough and wheeze were shared but many were not, and there was little evidence for an increased risk of future wheeze in children with isolated night cough. This provides little support for the hypothesis that recurrent cough without wheeze may indicate a variant form of asthma.

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Section: Introductionmentioning

confidence: 99%

Isolated night cough in children: how does it differ from wheeze?

et al. 2020

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“…Although none of the included studies was explicitly focused on clinical history and presentation of chronic cough in children, [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] it has been noted that positive personal and family history of atopy and a previous history of chronic cough were commonly detected in children affected by chronic cough. 11,16,[18][19][20] Passive tobacco exposure was commonly reported in patients with chronic cough.…”

Section: Clinical History and Symptomsmentioning

confidence: 99%

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

Marseglia

Manti

Chiappini

et al. 2021

aei

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The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to interprofessional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family. Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice.

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“…Cough-variant asthma (CVA) accounts for the highest proportion of chronic cough among school-age children, but its diagnosis is difficult [ 6 ]. Especially for nonspecific chronic cough, which lacks the associated clinical symptoms, diagnosis and therapy are relatively difficult [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Fractional Exhaled Nitric Oxide (FeNO) Integrating Airway Hyperresponsiveness (AHR) Examination Promotes Etiologic Diagnosis and Treatment for Children with Chronic Cough

Zhu

Hao

et al. 2020

Med Sci Monit

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Background Chronic cough is the main reason why parents seek medical treatment for their children. This study aimed to evaluate changes in airway function and inflammation levels and associated values in diagnosing and treating chronic cough. Material/Methods This study involved 118 children with chronic cough, including 45 cough-variant asthma (CVA) patients, 53 upper-airway cough syndrome (UACS) patients, and 20 post-infection cough (PIC) patients. Chronic cough was diagnosed as described by guidelines of the American College of Chest Physicians for evaluating chronic cough. Pulmonary ventilation function and airway hyperresponsiveness (AHR) were evaluated. Fractional exhaled nitric oxide (FeNO) levels and eosinophilic airway inflammation were measured. Eosinophil (EOS) count in sputum was also examined. CVA patients were treated with inhaled glucocorticoids, which have anti-inflammatory effects. Results FeNO and sputum EOS levels were higher in CVA patients compared with UACS and PIC patients ( P <0.05). CVA patients demonstrated significantly higher small airway indexes, including 25% forced expiratory flow (FEF), 50% FEF, and 75% FEF, compared with UACS and PIC patients ( P <0.05). FeNO level was positively correlated with EOS in sputum ( r =0.468, P =0.0001) and cough symptom scores ( r =0.402, P <0.05). FeNO, EOS, and cough symptoms were significantly improved in CVA patients after glucocorticoid treatment. AHR was improved in all chronic cough patients after treatment. Cough-relief CVA patients demonstrated significantly higher FeNO levels compared with those without cough relief ( P <0.05). Conclusions FeNO integrating pulmonary function and AHR examination can improve etiologic diagnosis and treatment for chronic cough in children.

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Etiology analysis of nonspecific chronic cough in children of 5 years and younger

Cited by 13 publications

References 18 publications

Isolated night cough in children: how does it differ from wheeze?

Isolated night cough in children: how does it differ from wheeze?

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

Fractional Exhaled Nitric Oxide (FeNO) Integrating Airway Hyperresponsiveness (AHR) Examination Promotes Etiologic Diagnosis and Treatment for Children with Chronic Cough

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