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Cough, cough receptors, and asthma in children
1Department of Respiratory Medicine, Mater Misericordiae Children's Hospital, South Brisbane, Queensland, Australia. achang@mater.org.au
Insights
Cough is common in children, but evidence for treating isolated cough with asthma or reflux medications is limited. Understanding the complex cough reflex is crucial for respiratory health.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Cough is a prevalent symptom in children (15-20%) and often treated empirically.
- Non-specific cough in children is frequently managed with asthma or gastroesophageal reflux medications, despite limited supporting evidence.
- Methodological challenges in cough research, including subjective measurements and spontaneous resolution, complicate clinical study interpretation.
Purpose of the Study:
- To review current concepts of cough in children, focusing on its relationship with asthma.
- To present models illustrating the link between cough, bronchoconstriction, and airway hyperresponsiveness.
- To propose a new model connecting cough receptor sensitivity, airway hyperresponsiveness, and clinical symptoms like cough, wheeze, and dyspnea.
Main Methods:
- Literature review of general concepts on cough in children.
- Analysis of existing models relating cough and bronchoconstriction.
- Development of a conceptual model for cough, airway hyperresponsiveness, and related symptoms.
Main Results:
- Cough is a common childhood symptom with significant diagnostic and therapeutic challenges.
- Evidence supporting the use of asthma or reflux medications for isolated cough in children is scarce.
- A new model is proposed to explain the interplay between cough receptor sensitivity, airway hyperresponsiveness, and clinical manifestations.
Conclusions:
- Cough is a vital protective reflex for respiratory health, essential for clearing secretions and preventing complications.
- The efficacy of common treatments for non-specific cough in children lacks robust evidence.
- Further research is needed to elucidate the complex cough reflex pathway and improve clinical management strategies.
Abstract:
This review discusses current general concepts on cough and the relationship between cough, cough receptor sensitivity, and asthma in children. It presents models of the relationship between cough and bronchoconstriction, and proposes a new model outlining the relationship between cough receptor sensitivity, airway hyperresponsiveness, and the clinical issues of cough, wheeze, and dyspnea in children with and without asthma. Cough is very common in children, with a prevalence of 15-20%. Those with non-specific cough (dry cough in the absence of identifiable respiratory illness) are often treated with a variety of drugs, in particular, medications for asthma and gastroesophageal reflux. However, there is little evidence to use these medications for the sole symptom of cough in children. Clinical studies on cough need to be interpreted in light of inherent methodological problems in studying cough. These methodological problems include the nonrepeatable nature of questions on cough, the unreliability of subjective measurements of cough, the lack of objective measurements to quantify cough severity, and the period effect (spontaneous resolution of cough). Although cough can be troublesome, cough serves as an important function for maintaining normal health of the respiratory system. The importance of cough in maintaining respiratory health is reflected in the development of lung atelactasis/collapse from retained secretions and recurrent pneumonia in clinical situations where the cough reflex is ineffective. The cough reflex is complex and still poorly understood. In this article the simplified cough pathway is presented and involves cough receptors, mediators of sensory nerves and the afferent pathway, the vagus nerve, the cough centre, efferent pathway, and cough effectors.