Objective Data on the aetiology of persistent cough at the transitional stage from subacute to chronic cough (>4 weeks duration) are scarce. We aimed to (1) identify the prevalence of chronic cough following acute respiratory illness (ARI) and (2) determine the diagnostic outcomes of children with chronic cough.
Design Prospective cohort study.
Setting A paediatric emergency department (ED) in Brisbane, Australia.
Patients Children aged <15 years presenting with an ARI with cough.
Interventions Children were followed weekly for 28 days;those with a persistent cough at day 28 were reviewed by a paediatric pulmonologist.
Main outcome measures Cough persistence at day 28 and pulmonologist diagnosis.
Results 2586 children were screened and 776 (30%) were ineligible; 839 children (median age=2.3 years, range=0.5 months to 14.7 years, 60% male) were enrolled over 2 years. Most children (n=627, 74.8%) had cough duration of <7 days at enrolment. At day 28, 171/839 (20.4%, 95% CI 17.7 to 23.1) children had persistent cough irrespective of cough duration at enrolment. The cough was wet in 59/171 (34.5%), dry in 45/171 (26.4%) and variable in 28/171 (16.1%). Of these 117 children , 117 (68.4%) were reviewed by a paediatric pulmonologist. A new and serious chronic lung disease was diagnosed in 36/117 (30.8%) children; 55/117 (47.0%) were diagnosed with protracted bacterial bronchitis.
Conclusions When chronic cough develops post-ARI, clinical review is warranted, particularly if parents report a history of prolonged or recurrent cough. Parents of children presenting acutely to ED with cough should be counselled about the development of chronic cough, as an underlying respiratory condition is not uncommon.
- chronic cough
- acute respiratory illness
- clinical outcomes
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Contributors KO’G conceived the study idea, formulated the research questions, wrote the study protocol and standard operating procedures and was responsible for the overall implementation of the study. She wrote the final draft of the manuscript. BJD contributed to the study protocol, participant recruitment and follow-up, and participated in writing of the the first draft of the manuscript. ABC contributed to the study protocol, study implementation and made a major contribution to the manuscript. NP contributed to the design of the study protocol and study implementation in the Emergency Department and reviewed and approved the final manuscript. JA contributed to design of the study protocol and study implementation in the Emergency Department and reviewed and approved the final manuscript. JMM contributed to design of the study protocol and study implementation in the Queensland Children’s Respiratory Centre and reviewed and approved the final manuscript. VG was responsible for the majority of the child reviews and follow-ups in the Queensland Children’s Respiratory Centre and reviewed and approved the final manuscript.
Funding This study was funded by Queensland Children’s Medical Research Institute/Queensland Children’s Health Foundation Program Grant. BJD was supported by a NHMRC Post-Graduate Scholarship (1075467). K-AO'G is supported by a NHMRC Career Development Fellowship (1045157) and Queensland Government Smart Futures Fellowship. VG is supported by a NHMRC Post-Graduate Scholarship (1075119). ABC is supported by NHMRC Practitioner Fellowship 1058213.
Competing interests None declared.
Ethics approval The study protocol was approved by the ethics committees of the Queensland Children’s Health Services (HREC/11/QRCH/83), The University of Queensland (2012000700) and the Queensland University of Technology (1400000057).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data from this study will be made available on request with the appropriate human research ethics committee clearances.
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