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

Abstract

BackgroundAcute respiratory illnesses with cough (ARIwC) are predominant causes of morbidity in Australian Indigenous children; however, data on disease burden in urban communities are scarce. This study aimed to determine the incidence of ARIwC, the predictors of recurrent (≥4 episodes) ARIwC, and development of chronic cough following an ARIwC in urban, predominantly Indigenous, children aged <5 years from northern Brisbane, Australia.MethodsProspective cohort study of children aged <5 years registered with a primary healthcare center. ARIwC episodes and outcomes were collected for 12 months. Recurrent ARIwC was defined as ≥4 episodes in 12 months. Chronic cough was defined as cough lasting >4 weeks. Children who developed chronic cough were reviewed by a pediatric pulmonologist. Incidence densities per child-month of observation were calculated and predictors of recurrent ARIwC and chronic cough were evaluated in logistic regression models.ResultsBetween February 2013 and November 2015, 200 children were enrolled; median age of 18.1 months, range (0.7–59.7 months) and 90% identified as Indigenous. A total of 1,722 child-months of observation were analyzed (mean/child = 8.58, 95% CI 8.18–9.0). The incidence of ARIwC was 24.8/100 child-months at risk (95% CI 22.3–27.5). Twenty-one children (10.5%) experienced recurrent ARIwC. Chronic cough was identified in 70/272 (25.7%) episodes of ARIwC. Predictors of recurrent ARIwC were presence of eczema, mold in the house, parent/carer employment status, and having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander). Predictors of chronic cough included being aged <12 months, eczema, childcare attendance, previous history of cough of >4 weeks duration, having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander), and a low income. Of those with chronic cough reviewed by a pediatric pulmonologist, a significant underlying disorder was found in 14 children (obstructive sleep apnea = 1, bronchiectasis = 2, pneumonia = 2, asthma = 3, tracheomalacia = 6).DiscussionThis community of predominantly Aboriginal and Torres Strait Islander and socially disadvantaged children bear a considerable burden of ARIwC. One in 10 children will experience more than three episodes over a 12-month period and 1 in five children will develop chronic cough post ARIwC, some with a serious underlying disorder. Further larger studies that include a broader population base are needed.

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

“…When including all children in the analysis, the prevalence of chronic cough post-acute cough in our study is similar to the 20-26% identified in other studies in South-East Queensland using the same methods and similar communities (6,10). Our study supports the findings of those studies with respect to risk factors for chronic cough (10,22), including preterm birth, illness duration at presentation and childcare. Preterm birth has been associated with a range of both acute and chronic respiratory illnesses (23,24).…”

“…However, although primary-care studies have reported 10% of children with an ARI are still coughing after day-25 (9), there are little data on the predictors of chronic cough in children. In our previous study, restricted to a single low-socioeconomic site, predictors of chronic cough were age <12-months, eczema, childcare attendance, previous history of chronic cough, parental Indigenous status, and low income (10). However, generalizability of these data is limited.…”

“…Risk factors for childhood ARIs include childcare attendance, now common in the modern era (10)(11)(12)(13)(14)(15)(16)(17). In 2017, >40% of Australian children aged <5-years attended childcare on a daily basis (18).…”

Wet Cough and Nasal Symptoms in Children: Can We Do Better?

“…Parents are often disturbed by cough and ask that "something is done." In a prospective study in Australian children, a high proportion of parents thought antibiotics should be given for post-infectious cough (34%) or were unsure (24%); surprisingly, antibiotics were prescribed in 14% of episodes characterized by isolated dry cough with no fever (46). Postinfectious cough is difficult to distinguish from PBB and this may complicate therapeutic decisions (9).…”

Respiratory, birth and health economic measures for use with Indigenous Australian infants in a research trial: A modified Delphi with an Indigenous panel

“…Infancy is a critical time to detect, and effectively manage respiratory illness. While up to 6 episodes of self-limiting respiratory illness is normal in the rst year of life (11,12), untreated chronic symptoms commonly lead to lifelong disease, poor quality of life and early death (10). Respiratory illnesses can be split into upper and lower.…”