Chronic Cough Often Reveals Underlying Illness in Children

Troy Brown, RN

August 24, 2017

Children who continue to cough 4 weeks after an acute respiratory illness (ARI) often have underlying respiratory pathology, a study has found. Almost one third (30.8%) of children evaluated by a pulmonologist for chronic cough (CC) after ARI were diagnosed with a new and serious lung disease, and 47.0% were found to have protracted bacterial bronchitis.

"CC is often the sole presenting symptom of an underlying chronic RI, and in some conditions, if left untreated, it may result in irreversible lung damage and chronic lung disease. Furthermore, CC impairs quality of life...and stresses parents, both of which normalise when the cough resolves," the researchers explain.

Kerry-Ann F. O'Grady, PhD, from the Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia, and colleagues report their findings in an article published online August 16 in the Archives of Disease in Childhood.

The study included 839 children younger than 15 years (median age, 2.3 years) who presented to a large pediatric emergency department (ED) with ARI. The researchers excluded children with chronic lung disease (except asthma) and/or immunosuppression, as well as those who had used immune-modulating drugs (except oral or inhaled steroids) in the 30 days before being seen in the ED. Most (n = 627; 74.8%) of the children had been coughing for less than 1 week at enrollment.

One fifth (171; 20.4%; 95% confidence interval [CI], 17.7% - 23.1%) of the children continued to cough at day 28.

Among those with chronic cough, 117 were evaluated by a pediatric pulmonologist. Of those who did not undergo pulmonology evaluation, the cough had resolved in 13 children before the evaluation could be completed, two children had positive polymerase chain reaction testing for pertussis in nasal swabs obtained at baseline, and one tested positive for Mycoplasma pneumoniae. The remaining children withdrew from the study for other reasons.

Pulmonology evaluation revealed a new chronic underlying lung disease in 36 (30.8%) children.

Protracted bacterial bronchitis was the most common diagnosis made during pulmonologist evaluation (n = 55/117; 47.0%), and 37/117 (31.6%) of the children received more than one diagnosis. Fourteen children were diagnosed with recurrent upper RIs, and four were diagnosed with pneumonia. Four children were diagnosed with aspiration disorders, three of whom were previously undiagnosed.

Forty children (34.2%) had one or more chronic RI. Of those, 17 (14.5%; nine were new diagnoses) had asthma, 13 (11.1%; 12 were new diagnoses) had tracheobronchomalacia, four (3.4%) had obstructive sleep apnea, four (3.4%) had aspiration disorder, and four (3.4%) had bronchiectasis.

The prevalence of CC in children at day 28 was higher in this study than in others (10%), the researchers say. "This potentially reflects the different setting in which our study was conducted (in ED vs primary care), particularly given that 63% of parents reported they had consulted other healthcare providers for their child's cough prior to ED presentation," they write.

"Acuity, parental concern and distress over their child's cough and the severity and stage of the child's illness are likely to have influenced the decision to present to an ED, the decision to enrol in the study and to complete the full period of follow-up."

The researchers caution that the findings cannot be extrapolated to primary care, as the study was based in a tertiary center.

"[O]ur study suggests that when CC is present post-ARI, these children warrant further attention. Discharge planning should include counselling parents to represent for appropriate physician review and consideration of underlying lung disease if their child continues to cough," the researchers conclude.

The authors have disclosed no relevant financial relationships.

Arch Dis Child. Published online August 16, 2017. Abstract

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