Associated Factors in Children With Chronic Cough

doi:10.1378/chest.09-0649

Chest

Volume 136, Issue 3, September 2009, Pages 811-815

https://doi.org/10.1378/chest.09-0649 Get rights and content

Background

Children presenting with chronic cough are common to the primary care physicians, but data on the etiology are scant.

Methods

We evaluated 40 children (age range, 5 to 12 years) with chronic cough (> 8 weeks duration) with no obvious cause who were referred by their primary care physicians. All patients underwent an extensive multispecialty workup that included pulmonary, GI, allergy, immunology, and otorhinolaryngology testing. Response to treatment was quantified pretreatment and 8 weeks after treatment by using a visual analog scale.

Results

Positive diagnostic test results were noted for gastroesophageal reflux disease (27.5%), allergy (22.5%), asthma (12.5%), infection (5%), aspiration (2.5%), and multiple etiologies (20%). Appropriate treatment for these factors resulted in a significant improvement in cough.

Conclusion

Reflux, allergy, and asthma accounted for > 80% of the likely etiologic factors of chronic cough in children and responded to a!ppropriate treatment.

Section snippets

Patients

Children with a cough duration of > 8 weeks were referred to the Pediatric Specialty Center at West Jefferson Medical Center and underwent the workup. They were all from the same geographic area. Patients were evaluated by and workup was directed by the same pulmonologist, gastroenterologist, allergist, immunologist, and otorhinolaryngologist. For inclusion in the study, the children had to have been born full term, be neurodevelopmentally appropriate for age, with no direct or indirect

Results

Forty consecutive children (mean age, 7.8 years; age range, 5 to 12 years; 17 were female, and 23 were male) fulfilling all entry criteria were included in the study. The duration of cough ranged from 8 to 36 weeks (mean [± SD] duration, 18 ± 6 weeks). The associated factors are listed in Table 1. One or more associated and potentially causative factors were identified in 90% of children. The single most common factor associated with chronic cough by itself was gastroesophageal reflux disease

Discussion

This is the first study to comprehensively evaluate children with chronic cough and without a selective workup. Our study suggests that among children with chronic cough (ie, cough of > 8 weeks duration), the most common likely causative factors were allergy, reflux, and asthma. Most children with allergy were found to have upper airway cough syndrome (previously designated as postnasal drip syndrome). Nocturnal cough was more common in the asthma and allergy groups compared with the reflux

Acknowledgments

Author contributions: Drs. Khoshoo, Edell, Haydel, and Saturno conceived the study, developed the protocol, and managed the patients. Ms. Mohnot and Dr. Kobernick contributed to the data analysis. Dr. Khoshoo wrote the first draft.

Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

References (0)

Cited by (52)

Respiratory Tract Symptom Complexes
2018, Principles and Practice of Pediatric Infectious Diseases
Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report
2017, Chest
Citation Excerpt :
Data were extracted by a single author (A. C.) and checked by a second author (J. O.). For cohort studies, we reported on the study’s setting, number enrolled and completing the study, inclusion and exclusion criteria, as well as other factors (Table 121-32) we considered important for interpretation of studies on chronic cough specific to the KQs. These factors included a definition for diagnoses, how cough was measured and resolution defined, and whether or not the period effect was considered a priori.
There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children?
We used the CHEST Expert Cough Panel’s protocol and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients’ values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus.
Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies.
There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.
Cough in children
2014, Archivos de Bronconeumologia
Citation Excerpt :
Exposure to tobacco smoke and other environmental contaminants and smoking by the children and adolescents themselves are a common cause of cough or the failure of cough to resolve at all ages.4 Sometimes there may be more than one underlying cause, and an integral etiological approach to this disease in children is fundamental in order to assign appropriate treatment.16–21 One way of approaching cough in children is to evaluate it according to the length of time that symptoms have been present.
Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4–8 weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.
La tos en la infancia es un síntoma muy frecuente, y constituye uno de los motivos de consulta más comunes en la práctica pediátrica diaria. Las causas de tos en el niño son diferentes a las del adulto y se deben seguir las guías específicas de la edad pediátrica para su diagnóstico y tratamiento. En la mayoría de casos la causa son infecciones respiratorias banales que producen una «tos normal o esperada», pero todo niño con tos que persiste más allá de las 4 a 8 semanas se considera que tiene «tos crónica» y debe ser evaluado para descartar patologías específicas que abarcan todo el espectro de la neumología pediátrica. El tratamiento de la tos debe realizarse en función de la etiología. Con un abordaje adecuado se puede identificar la misma hasta en el 80% de los casos y el tratamiento será efectivo en el 90% de ellos. En algunos casos de «tos crónica inespecífica», tos en la que se ha descartado patología subyacente, se puede realizar un tratamiento empírico en función de las características de la tos. No hay evidencia científica que justifique el empleo de tratamientos sintomáticos que alivien la tos, como jarabes antitusivos, mucolíticos y/o antihistamínicos, ya que pueden tener efectos secundarios potencialmente graves, por lo que no se deben emplear.
Case 6-2015: A 16-year-old boy with coughing spells
2014, New England Journal of Medicine
Citation Excerpt :
Common causes of prolonged cough include asthma, gastroesophageal reflux disease, and the upper-airway cough syndrome (Table 1). Together, these causes accounted for 64% of the diagnoses in a prospective study of children with chronic cough.3 Other causes include passive or active smoking, cystic fibrosis, foreign-body aspiration, extrinsic airway compression, and interstitial lung disease.4,5
A 16-year-old boy presented with a 3-week history of cough and nasal congestion and a 3-day history of severe coughing spells, post-tussive emesis, and trouble breathing. A chest radiograph was normal. A diagnostic test was performed.
Presentation of Case
Dr. Mark A. Goldstein (Pediatrics): A 16-year-old boy was seen in the adolescent medicine outpatient clinic of this hospital in late spring because of coughing spells.
The patient had been well until approximately 3 weeks before the current presentation, when cough and nasal congestion developed and persisted, without fever or chills. He took fexofenadine hydrochloride, without improvement. Three days before the current presentation, he awoke at night with a severe coughing spell, with associated post-tussive emesis and trouble breathing. His parents took him to the emergency department of another hospital. On examination, he appeared to be in . . .
Protracted bacterial bronchitis: more to know
2022, Journal of Biological Regulators and Homeostatic Agents
GER and Respiratory Diseases
2022, Gastroesophageal Reflux in Children: Second Edition

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This article was presented in part at the Annual Conference of American College of Chest Physicians, Chicago, IL, October 24, 2007.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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Chest

Original ResearchCoughAssociated Factors in Children With Chronic Cough

Background

Methods

Results

Conclusion

Section snippets

Patients

Results

Discussion

Acknowledgments

Original Research
Cough
Associated Factors in Children With Chronic Cough