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Persistent cough in children and the overuse of medications
F Thomson1, I B Masters, A B Chang
1Department of Paediatrics, Mater Children's Hospital, South Brisbane, Australia.
Insights
Overdiagnosis of asthma is common in children with persistent cough, leading to unnecessary medication use and side effects. Careful evaluation is crucial to ensure accurate diagnosis and appropriate treatment for pediatric cough.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
Background:
- Persistent cough in children is a common referral reason to tertiary respiratory clinics.
- Previous diagnoses and treatments may not always be accurate or effective.
Purpose of the Study:
- To evaluate diagnoses, medication use, and side effects in children with persistent cough.
- To assess the accuracy of initial asthma diagnoses and the impact of pre-referral treatments.
Main Methods:
- Prospective data collection over 12 months in a tertiary respiratory setting.
- Inclusion of children with persistent cough (>= 4 weeks).
- Evaluation of referring and final diagnoses, and medication history.
Main Results:
- 61.2% of referred children were initially diagnosed with asthma.
- High pre-referral medication use, with 12.9% experiencing steroid side effects.
- Airway lesions were common, often with co-existing diagnoses like aspiration or reflux; no child had asthma as the sole final diagnosis.
Conclusions:
- Overdiagnosis of asthma and overuse of asthma medications are prevalent in pediatric persistent cough.
- Thorough evaluation is essential to avoid unnecessary treatments and monitor medication response.
- Accurate diagnosis in pediatric persistent cough can reduce medication-related side effects.
Objective:
Children referred for persistent cough were evaluated for the referring and final diagnosis, and the extent of the use of medications prior to referral and the side effects encountered.
Methods:
Data on children seen by respiratory paediatricians for persistent cough (> or =4 weeks) in a tertiary respiratory setting were collected prospectively over 12 months.
Results:
Of the 49 children, 61.2% were diagnosed with asthma at referral, with similar referral rates from general practitioners and paediatricians. Children with isolated cough were just as likely to have been diagnosed with asthma as children with cough and wheeze. Medication use (asthma, gastro-oesophageal reflux and antibiotics) prior to referral was high, asthma medications were most common, and of these 12.9% had significant steroid side effects. The most common abnormality found (46.9%) was a bronchoscopically defined airway lesion, and in 56.5% of these children, another diagnosis (aspiration, achalasia, gastro-oesophageal reflux) existed. No children had a sole final diagnosis of asthma and pre-referral medications were weaned in all children.
Conclusion:
Over diagnosis of asthma and the overuse of asthma treatments with significant side effects is common in children with persistent cough referred to a tertiary respiratory clinic. Children with persistent cough deserve careful evaluation to minimize the use of unnecessary medications and, if medications are used, assessment of response to treatment is important.