Trajectories of cough without a cold in early childhood and associations with atopic diseases

Divaret‐Chauveau, Amandine; Mauny, Frédéric; Hose, Alexander; Depner, Martin; Dalphin, Marie‐Laure; Kaulek, Vincent; Barnig, C.; Schaub, Bianca; Schmaußer‐Hechfellner, Elisabeth; Renz, Harald; Riedler, Josef; Pekkanen, Juha; Karvonen, Anne M.; Täubel, Martin; Lauener, Roger; Roduit, Caroline; Vuitton, Dominique A.; Demoulin‐Alexikova, Silvia; Kirjavainen, Pirkka V.; Roponen, Marjut; Laurent, Lucie; Theodorou, Johanna; Böck, A.; Pechlivanis, Sonali; Ege, Markus; Genuneit, Jon; Illi, Sabina; Kabesch, Michael; Pfefferle, Petra Ina; Frei, Remo

doi:10.1111/cea.14257

Cited by 3 publications

(16 citation statements)

References 39 publications

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“…Divaret-Chauveau et al and Rancière et al investigated cough without cold and dry night cough trajectories, respectively. [28, 38] Both studies used only cough questions collected at different time points to define cough trajectories/patterns, but they included children who wheeze; and the children were also younger (Table S6). In an analysis stratified by presence or absence of wheeze, Divaret-Chauveau et al found physician-diagnosed asthma reported among a small proportion of children in all cough trajectories (2 to 12%) even in the absence of wheeze.…”

Section: Discussionmentioning

confidence: 99%

“…In an analysis stratified by presence or absence of wheeze, Divaret-Chauveau et al found physician-diagnosed asthma reported among a small proportion of children in all cough trajectories (2 to 12%) even in the absence of wheeze. [28] Rancière et al also reported physician-diagnosed asthma ever in all cough patterns (7 to 26%) but this included children who wheeze. [38] In our study, parent-reported, physician-diagnosed asthma ever was also reported in all identified cough phenotypes, yet in much higher proportions (22 to 55%).…”

Section: Discussionmentioning

confidence: 99%

“…Divaret-Chauveau et al also concluded as such; they found an association between different cough trajectories and asthma/allergic rhinitis. [28] Similarly, Rancière et al found an association between children with rising cough patterns-late and persistent coughers-and allergic comorbidity, including asthma, and atopy, independent of the presence of wheeze. [38] Additionally, the relatively high proportion of children reporting wheeze at follow-up (overall: 22%, range 10 to 29% for all 4 phenotypes) supports the need for further asthma work-ups.…”

Section: Interpretation and Implication Of Findingsmentioning

confidence: 92%

“…We cannot fully compare our findings with population-based studies also using LCA or similar clustering techniques to distinguish cough phenotypes. [15,[26][27][28]38] We provide a summary of study designs and populations, inclusion criteria, indicator variables, identified phenotypes/trajectories, and validation processes from existing studies in Table S6. Spycher et al and Weinmayr et al included children who wheeze and used mostly wheeze-related symptoms with only few questions about cough as indicator variables in the LCA.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…[15][16][17] Although LCA is widely used to classify children with wheeze, asthma, or bronchiolitis, [18][19][20][21][22][23][24][25] few have applied LCA to children presenting with recurrent cough. [15,[26][27][28] Present studies were population-based, thus mainly included children with rather mild disease, many of whom had not seen a paediatric respiratory specialist for cough. In addition, most studies were either focused on asthma and wheeze with little emphasis on cough-thus limiting identification of cough phenotypes [15,26,27] -or included measurable physiological traits for phenotype definition, which limits use across healthcare settings with restricted or no access to diagnostic tests.…”

Section: Introductionmentioning

confidence: 99%

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Phenotypes of cough in children: a latent class analysis

Mallet¹,

Pedersen²,

Makhoul³

et al. 2023

Preprint

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Background: Distinguishing phenotypes among children with cough helps understand underlying causes. Using a statistical data-driven approach, we identified cough phenotypes and we aimed to validate them based on measurable traits, physician diagnoses, and prognosis. Methods: We used data from 531 children aged 5-16 years from the Swiss Paediatric Airway Cohort - a multicentre clinical cohort of children seen in outpatient clinics since 2017. We included children with any parent-reported cough (i.e. cough without a cold, cough at night, cough more than others, or cough longer than 4 weeks) without current wheeze. We applied latent class analysis to identify phenotypes using 9 symptoms and characteristics and selected the best model using the Akaike Information Criterion. We assigned children to the most likely phenotype and compared the resulting groups with regards to parental history, comorbidities, measurable traits, physician diagnoses, and prognosis after 1 year. Results: Our analysis distinguished 4 cough phenotypes: 1. unspecific dry cough (25%); 2. non-allergic infectious and night cough with snoring and otitis (4%); 3. allergic dry night cough with snoring (9%); and 4. allergic cough (61%). Children with the allergic phenotype often had family or personal history of atopy and were diagnosed with asthma. Fractional exhaled nitric oxide was highest for the allergic phenotype [median 17.9 parts per billion (ppb)] and lowest for the non-allergic infectious phenotype (median 7.0 ppb). Positive allergy test results differed across phenotypes (p<0.001) and were most common among the allergic (70%) and least common among the unspecific dry cough (31%) phenotypes. Subsequent wheeze was thrice as high among the allergic than the unspecific dry cough phenotype. Conclusion: We distinguished 4 clinically-relevant cough phenotypes; they differed by measurable traits, physician diagnoses, and prognosis. Although we excluded children with current wheeze, most children belonged to allergy-related phenotypes and possibly need allergy and asthma work-ups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Interpretation and Implication Of Findingsmentioning

confidence: 92%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Phenotypes of cough in children: a latent class analysis

Mallet¹,

Pedersen²,

Makhoul³

et al. 2023

Preprint

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Diagnosis in children with prolonged or recurrent cough: findings from the Swiss Paediatric Airway Cohort

Mallet,

Elmiger,

Glick

et al. 2024

Preprint

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Introduction: Prolonged or recurrent cough is a common reason for referral to pediatric pulmonologists, yet few studies have assessed its causes. We examined records of children visiting respiratory outpatient clinics in Switzerland and assessed how diagnoses vary by age. Methods: We analyzed data from the multicenter Swiss Paediatric Airway Cohort study. We included 363 children (median age 6 years, range 0-16) referred for prolonged or recurrent cough. From outpatient records, we extracted information on diagnostic investigations, final diagnoses proposed by pediatric pulmonologists, and treatments prescribed. Results: Asthma and asthma-like conditions (cough variant asthma, episodic viral wheeze, and recurrent obstructive bronchitis) was diagnosed in 132 (36%) of 363 children, respiratory tract infections (RTI) including protracted bacterial bronchitis (PBB) in 51 (14%), upper airway cough syndrome (UACS) in 48 (13%), postinfectious cough in 36 (10%); other diagnoses including gastroesophageal reflux disease (GERD) and somatic cough syndrome or tic cough were found in 23 (6%). No etiology was found in 73 children (20%). Asthma was diagnosed 3.5 times more often in schoolchildren while RTI including PBB was diagnosed 3 times more often in preschoolers. Inhaled corticosteroids were prescribed for 84% of children diagnosed with asthma and asthma-like conditions, antibiotics for 43% of children with RTI, and nasal corticosteroids for 83% of those with UACS. Conclusion: Coughing children received a wide spectrum of diagnoses that differed between preschool and schoolchildren. Asthma accounted for 36% of diagnoses, which emphasizes the importance of comprehensive investigation beyond asthma in children with prolonged or recurrent cough.

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Phenotypes of cough in children: A latent class analysis

Mallet,

Pedersen,

Makhoul

et al. 2023

Clin Experimental Allergy

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IntroductionDistinguishing phenotypes among children with cough helps understand underlying causes. Using a statistical data‐driven approach, we aimed to identify and validate cough phenotypes based on measurable traits, physician diagnoses, and prognosis.MethodsWe used data from the Swiss Paediatric Airway Cohort and included 531 children aged 5–16 years seen in outpatient clinics since 2017. We included children with any parent‐reported cough (i.e. cough without a cold, cough at night, cough more than other children, or cough longer than 4 weeks) without current wheeze. We applied latent class analysis to identify phenotypes using nine symptoms and characteristics and selected the best model using the Akaike information criterion. We assigned children to the most likely phenotype and compared the resulting groups for parental atopy history, comorbidities, spirometry, fractional exhaled nitric oxide (FeNO), skin prick tests and specific IgE, physician diagnoses, and 1‐year prognosis.ResultsWe identified four cough phenotypes: non‐specific cough (26%); non‐allergic infectious and night cough with snoring and otitis (4%); chronic allergic dry night cough with snoring (9%); and allergic non‐infectious cough with rhino‐conjunctivitis (61%). Children with the allergic phenotype often had family or personal history of atopy and asthma diagnosis. FeNO was highest for the allergic phenotype [median 17.9 parts per billion (ppb)] and lowest for the non‐allergic infectious phenotype [median 7.0 parts per billion (ppb)]. Positive allergy test results differed across phenotypes (p < .001) and were most common among the allergic (70%) and least common among the non‐specific cough (31%) phenotypes. Subsequent wheeze was more common among the allergic than the non‐specific phenotype.ConclusionWe identified four clinically relevant cough phenotypes with different prognoses. Although we excluded children with current wheeze, most children with cough belonged to allergy‐related phenotypes.

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Trajectories of cough without a cold in early childhood and associations with atopic diseases

Abstract: Background: Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood.

Cited by 3 publications

References 39 publications

Phenotypes of cough in children: a latent class analysis

Phenotypes of cough in children: a latent class analysis

Diagnosis in children with prolonged or recurrent cough: findings from the Swiss Paediatric Airway Cohort

Phenotypes of cough in children: A latent class analysis

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