Chest
Volume 142, Issue 4, October 2012, Pages 943-950
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Original Research
Signs and Symptoms of Chest Diseases
A Multicenter Study on Chronic Cough in Children: Burden and Etiologies Based on a Standardized Management Pathway

https://doi.org/10.1378/chest.11-2725Get rights and content

Background

While the burden of chronic cough in children has been documented, etiologic factors across multiple settings and age have not been described. In children with chronic cough, we aimed (1) to evaluate the burden and etiologies using a standard management pathway in various settings, and (2) to determine the influence of age and setting on disease burden and etiologies and etiology on disease burden. We hypothesized that the etiology, but not the burden, of chronic cough in children is dependent on the clinical setting and age.

Methods

From five major hospitals and three rural-remote clinics, 346 children (mean age 4.5 years) newly referred with chronic cough (> 4 weeks) were prospectively managed in accordance with an evidence-based cough algorithm. We used a priori definitions, timeframes, and validated outcome measures (parent-proxy cough-specific quality of life [PC-QOL], a generic QOL [pediatric quality of life (PedsQL)], and cough diary).

Results

The burden of chronic cough (PC-QOL, cough duration) significantly differed between settings (P = .014, 0.021, respectively), but was not influenced by age or etiology. PC-QOL and PedsQL did not correlate with age. The frequency of etiologies was significantly different in dissimilar settings (P = .0001); 17.6% of children had a serious underlying diagnosis (bronchiectasis, aspiration, cystic fibrosis). Except for protracted bacterial bronchitis, the frequency of other common diagnoses (asthma, bronchiectasis, resolved without specific-diagnosis) was similar across age categories.

Conclusions

The high burden of cough is independent of children's age and etiology but dependent on clinical setting. Irrespective of setting and age, children with chronic cough should be carefully evaluated and child-specific evidence-based algorithms used.

Trial registry

Australian New Zealand Clinical Trials registry; No.: ACTRN12607000526471; URL: www.anzctr.org.au

Section snippets

Materials and Methods

This prospective multicenter cohort study was conducted in five major hospitals (Brisbane, Melbourne, Sydney, Canberra, and Darwin) and three rural-remote clinics (Orange [New South Wales], Anangu Pitjanjatjara Lands in Central Australia [South Australia], and Thursday Island [Queensland]). The study is an extension of our randomized controlled trial (RCT) that examined the early (2 weeks) vs delayed (6 weeks) use of cough pathway algorithm.16 Of the 346 children included in this study, 253

Results

The demographics of the 346 children (Table 1) were significantly different between the sites for several variables: household smoke exposure (lowest in Brisbane, highest in Darwin), number of children with wet cough (lowest in Canberra, highest in Brisbane), use of asthma medications (lowest in rural sites, highest in Canberra), number of indigenous children (lowest in Melbourne, highest in rural sites), and referral pattern. Age, sex, and number of siblings were not significantly different

Discussion

In this first prospective multicenter cohort study, we used an evidence-based cough algorithm to manage the chronic cough of 346 newly referred children. Using validated cough outcome measures and a priori definitions and timeframes to define cough resolution, we found that the burden of chronic cough (PC-QOL) differed significantly between clinical settings, but was not influenced by age, nor etiology of cough. There was a wide spectrum of etiology of chronic cough that was significantly

Acknowledgments

Author contributions: Dr Chang had full access to the data and takes responsibility for the integrity of all of the data and the accuracy of the data analysis.

Dr Chang: contributed to drafting, preparing, and critically reviewing the manuscript, was responsible for the study concept and design, and coordinated the study.

Dr Robertson: contributed to the study design; data collection, analyses, and interpretation; and revising the manuscript.

Dr Van Asperen: contributed to the study design; data

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    Funding/Support: This study is funded by an Australian National Health and Medical Research Council (NHMRC) project grant [490321]. Dr Chang is supported by a NHMRC fellowship [545216].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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