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

Abstract

Background and Objective: Data on the predictors of chronic cough development in young children are scarce. Our primary objective was to examine the factors associated with young children developing a chronic cough, with a focus on childcare attendance. Methods: A secondary analysis of data collected in a prospective cohort study of children presenting to three emergency departments and three primary healthcare centers in southeast Queensland, Australia. Eligible children where those aged <6-years presenting with cough and without known underlying chronic lung disease other than asthma. Children were followed for 4 weeks to ascertain cough duration. The primary outcome was persistent cough at day-28. Logistic regression models were undertaken to identify independent predictors of chronic cough including sensitivity analyses that accounted for children with unknown cough status at day-28. Results: In 362 children, 95 (26.2%) were classified as having chronic cough. In models that included only children for whom cough status was known at day-28, symptom duration at enrolment, age <12 months [adjusted odds ratio (aOR) 4.5, 95% confidence interval (CI) 1.1, 18.7], gestational age (aOR 3.2, 95%CI 1.4, 7.9), underlying medical conditions (aOR 2.6, 95% CI 1.3, 5.5), a history of wheeze (aOR 2.6, 95% CI 1.4, 4.8) and childcare attendance (aOR 2.3, 95% CI 1.2, 4.4) were independent predictors of chronic cough. Amongst childcare attendees only, 64 (29.8%) had chronic cough at day-28. The strongest predictor of chronic cough amongst childcare attendees was continued attendance at childcare during their illness (aOR = 12.9, 95% CI 3.9, 43.3). Conclusion: Gestational age, underlying medical conditions, prior wheeze and childcare attendance are risk factors for chronic cough in young children. Parents/careers need to be aware of the risks associated with their child continuing to attend childcare whilst unwell and childcare centers should reinforce prevention measures in their facilities.

Predictors of the Development of Protracted Bacterial Bronchitis following Presentation to Healthcare for an Acute Respiratory Illness with Cough: Analysis of Three Cohort Studies

“…Similar to the primary studies on the development of chronic cough [6,8,19], our study found that childcare attendance, young age, and a prior history of chronic cough were risk factors for PBB development. Amongst children in childcare, those who continued to attend while unwell with a cough illness were 13 times (adjusted odds ratio (OR) = 12.9, 95% CI 3.9, 43.3) more likely to develop chronic cough than those who remained absent [19].…”

“…Similar to the primary studies on the development of chronic cough [6,8,19], our study found that childcare attendance, young age, and a prior history of chronic cough were risk factors for PBB development. Amongst children in childcare, those who continued to attend while unwell with a cough illness were 13 times (adjusted odds ratio (OR) = 12.9, 95% CI 3.9, 43.3) more likely to develop chronic cough than those who remained absent [19]. Moreover, when children with chronic wet cough undergoing bronchoscopy were compared with children undergoing bronchoscopy for indications other than a cough, those with PBB were more likely to have attended childcare (OR 8.4, 95% CI 2.3-30.5), although this effect was no longer significant on multivariable analyses [20].…”

Risk factors for school-based presenteeism in children: a systematic review

“…For instance, some schools promote school attendance by rewarding individual children and school classes for good attendance and fining parents for child absences [ 53 ]. On the other hand, although the research about presenteeism among children is limited, there is evidence to suggest that presenteeism may adversely impact children’s health and education [ 15 , 16 ] as well as contributing to the spread of infection. More research is needed to explore the full extent of the health and educational effects of presenteeism among children.…”

“…Factors associated with presenteeism in children have been less well explored. Outbreaks of infectious illnesses within educational settings are common, particularly in England’s primary schools [ 14 ], which can lead to increased rates of hospital attendance among children [ 15 ], impacting children’s health and education. One study in Peru, among university students also found a significant association between presenteeism and reduced academic performance, which had a greater effect size than the impact of absenteeism on academic performance [ 16 ].…”

Prevalence of Infectious Diseases in Children at Preschool Education Institutions and Stakeholder Opinions

“…Nesti and Goldbaum stated that the risk of infection among children at preschool education centers has increased 2-3 times, which is a significant issue in terms of both personal health and community health [4]. Several other studies indicate the prevalence of infectious diseases and the increased risk of infection at preschool education institutions [5][6][7][8][9][10][11][12][13][14][15][16]. They are identified as a risk factor in the spread of infectious diseases; however, the solution to this risk does not involve keeping children away from them.…”