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Chest radiography in supporting the diagnosis of asthma in children with persistent cough
Claudia Halaby1, Martin Feuerman, Dan Barlev
1Winthrop University Hospital, Pediatric Pulmonary Division, Mineola, NY. chalaby@winthrop.org.
Insights
Chest X-rays showing lower airway obstruction (LAO) can help diagnose asthma in children with persistent cough. These findings are particularly useful for younger children who cannot perform spirometry.
Area of Science:
- Pediatric Pulmonology
- Diagnostic Imaging
- Respiratory Medicine
Background:
- Persistent cough in children is a common reason for pediatric pulmonary subspecialty referral.
- Diagnosing asthma, particularly cough-variant asthma, can be challenging in pediatric patients.
- Chest radiography is frequently utilized in the initial evaluation of pediatric respiratory symptoms.
Purpose of the Study:
- To determine if chest radiographic findings suggestive of lower airway obstruction (LAO) support the diagnosis of asthma in pediatric patients presenting with persistent cough.
- To evaluate the utility of radiographic signs of LAO in differentiating asthma from other causes of chronic cough in children.
- To assess the correlation between radiographic findings and spirometry results in pediatric asthma diagnosis.
Main Methods:
- A retrospective chart review of 180 pediatric patients (aged 1-18 years) with cough lasting ≥ 4 weeks was conducted.
- Chest radiographs of patients diagnosed with cough-variant asthma (n=90) were compared to those with non-asthma persistent cough (n=90) and a control group (n=90).
- Radiographic findings suggestive of LAO included increased peribronchial markings/cuffing and hyperinflation.
Main Results:
- Children diagnosed with cough-variant asthma exhibited higher rates of LAO-suggestive radiographic findings (30.00%) compared to non-asthma cough (17.80%) and controls (8.16%) (P=0.0063).
- Patients with LAO-suggestive findings on chest X-ray were significantly younger (5.0 ± 2.7 years) than those with normal findings (8.6 ± 4.7 years) (P < 0.0001).
- Higher rates of spirometry abnormalities indicative of LAO defects were also observed in the asthma group.
Conclusions:
- Chest radiographic findings suggestive of LAO can aid in supporting the diagnosis of asthma in pediatric patients with persistent cough.
- These imaging findings are especially valuable in younger children who may be unable to reliably perform spirometry.
- Integrating radiographic evidence of LAO with clinical presentation enhances diagnostic confidence for pediatric asthma.
Objective:
To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting.
Methods:
180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease.
Results:
Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001).
Conclusion:
This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.
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