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Evaluation and outcome of young children with chronic cough
Julie M Marchant1, I Brent Masters, Simone M Taylor
1Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, QLD, Australia. Julie_Marchant@health.qld.gov.au
Insights
An adult approach to chronic cough is unsuitable for children. Protracted bacterial bronchitis is a common cause in kids, unlike asthma or GERD seen in adults.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Chronic cough in children requires distinct diagnostic approaches.
- Adult-based algorithms for chronic cough may not be applicable to pediatric populations.
- Understanding pediatric-specific etiologies is crucial for effective management.
Purpose of the Study:
- To assess the efficacy of an adult-derived algorithmic approach for diagnosing chronic cough in children.
- To identify the primary causes of chronic cough in a pediatric cohort.
Main Methods:
- Prospective cohort study of 108 children with cough > 3 weeks.
- Utilized flexible bronchoscopy and bronchoalveolar lavage (BAL) for airway cytology.
- Followed a diagnostic pathway until cough resolution or diagnosis.
Main Results:
- Protracted bacterial bronchitis (PBB) was the most frequent diagnosis (39.8%).
- BAL fluid analysis aided diagnosis in 45.4% of cases.
- Asthma, GERD, and UACS were infrequent (<10%) in this pediatric cohort.
Conclusions:
- Adult-based chronic cough algorithms are largely unsuitable for young children.
- Pediatric chronic cough etiologies differ significantly from adult causes.
- Diagnostic strategies must be tailored to the pediatric population.
Objective:
To evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children with a history of > 3 weeks of cough and to describe the etiology of chronic cough in this cohort.
Methods:
A prospective cohort study of children referred to a tertiary hospital with a history of > 3 weeks of cough between June 2002 and June 2004. All included children followed a pathway of investigation (including flexible bronchoscopy and evaluation of airway cytology via BAL) until diagnosis was made and/or their cough resolved.
Results:
In our cohort of 108 young children (median age 2.6 years), the majority had wet cough (n = 96; 89%), and BAL fluid samples obtained during bronchoscopy led to a diagnosis in 45.4% (n = 49). The most common final diagnosis was protracted bacterial bronchitis (n = 43; 39.8%). These patients had neutrophil levels on BAL samples that were significantly higher than those in other diagnostic groups (p < 0.0001). Asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS), which are common causes of chronic cough in adults, were found in < 10% of the cohort (n = 10).
Conclusions:
The adult-based anatomic pathway, which involves the investigation and treatment of patients with asthma, GERD, and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults.
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