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Editor,—Faniran et alused a parental questionnaire to show that atopy was no more common in children aged 6–12 years with chronic cough than in “asymptomatic” children, whereas significantly more children with a history of wheeze showed evidence of atopy by skin testing.1 Children who wheezed at any time during the previous 12 months were designated to the “recent wheeze” group but chronic cough was defined as an episode of cough lasting more than three weeks, excluding those whose cough was associated with a cold or flu.
In asthmatic patients, wheeze is commonly associated with viral upper respiratory tract infection. If recurrent cough were to be considered as a mild variant of asthma then children who cough without wheeze after viral infection would be considered as asymptomatic in this study.
Faniran et al’s findings are at a variance with a clinical study of children younger than 6 years referred to a district general hospital because of either chronic or recurrent cough or wheeze. We found evidence of atopy by skin testing in 63% of those with cough compared with 75% of children referred with both cough and wheeze, and only 10% of children without respiratory symptoms.2 Two years after presentation 25% of those with cough alone reported at least one episode of wheeze but most showed improvement in respiratory symptoms.3
A history of cough or wheeze is subjective and varies with time. For each patient a careful clinical appraisal may indicate various causes, such as viral upper or lower respiratory infection, upper airway obstruction or habitual cough. If the pattern of presentation of cough alone resembles asthma and the child is too young to cooperate with lung function tests then a trial of asthma treatment with inhaled bronchodilators or even inhaled steroids is logical.
Dr Faniran et al comment:
As opposed to Dr Lewis’s comments, atopy was measured by skin prick test in all the 1245 children included in our study and not only in children with wheeze. We found that children with persistent cough had less morbidity and less atopy compared with children with wheeze.1-1 This finding is in agreement with other epidemiological studies1-2 1-3 in contrast to the hospital based studies referred to by Dr Lewis.1-4 As stated in our paper, we believe clinic attenders with persistent cough are unlikely to be representative of children in the community with this syndrome and may have symptoms with a different cause. As such, it might be inappropriate to treat children in the community with persistent cough as asthmatic. Rather, it is important to carry out studies to determine the appropriate treatment for these children.
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