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Chronic cough in children
Harrison Cash1, Samuel Trosman2, Thomas Abelson2
1Case Western Reserve University School of Medicine, Cleveland, Ohio.
Insights
Pediatric chronic cough diagnoses in otolaryngology differ from primary care, with infection, airway hyperreactivity, and GERD being most common. Treatment failure suggests airway hyperreactivity, warranting further investigation.
Area of Science:
- Otolaryngology
- Pediatric Pulmonology
- Pediatric Gastroenterology
Background:
- Chronic cough is a frequent pediatric complaint with limited diagnostic and therapeutic outcome data.
- Understanding causes and treatments in otolaryngology is crucial for effective patient management.
Purpose of the Study:
- To characterize pediatric chronic cough patients in otolaryngology clinics.
- Identify common etiologies and treatments for pediatric chronic cough.
- Evaluate the effectiveness of treatments for pediatric chronic cough.
Main Methods:
- Retrospective analysis of 58 pediatric patients with chronic cough (>4 weeks) from 2009-2013.
- Evaluation included history, physical exam, flexible laryngoscopy, imaging, and airway assessments.
- Treatment was based on working diagnoses, with outcomes assessed by cough resolution.
Main Results:
- Top diagnoses: infection (34%), airway hyperreactivity (24%), and gastroesophageal reflux disease (GERD) (24%).
- 83% of patients responded to initial treatment; 17% required further evaluation.
- Treatment failure strongly correlated with airway hyperreactivity (P<.001); chest radiography was more common and informative in these cases.
Conclusions:
- Pediatric chronic cough in otolaryngology settings presents differently than in primary care.
- Infection, airway hyperreactivity, and GERD are the leading causes.
- Persistent cough after initial treatment necessitates further evaluation, including chest radiography and pulmonary consultation.
Importance:
Chronic cough is a common complaint among pediatric patients, but little information exists on the types of diagnoses in these patients and therapeutic outcomes.
Objective:
To characterize pediatric patients with chronic cough presenting to otolaryngology clinics, identify common causes and treatments, and evaluate therapeutic outcomes.
Design, Setting, And Participants:
In this retrospective analysis, all medical records for pediatric patients seen at 2 otolaryngology clinics at a single tertiary care academic medical center from January 2009 through June 2013 were searched for relevant diagnostic codes. Patients younger than 18 years presenting with chronic cough (cough of >4 weeks' duration) were selected for study; 58 patients met the inclusion criteria and were selected for analysis.
Interventions:
Each patient was evaluated by the clinician via history, physical examination, and various tests and procedures, depending on the individual case, including flexible laryngoscopy, imaging tests, and/or airway evaluations. Each patient underwent treatment based on the working diagnosis.
Main Outcomes And Measures:
Primary outcomes included final diagnosis, response to treatment (as indicated by resolution of cough after initial therapy), and diagnostic workup undergone.
Results:
Among the 58 included patients, the 3 most common diagnoses were related to infection (n = 23; 34%), airway hyperreactivity (n = 14; 24%), or gastroesophageal reflux disease (n = 14; 24%). Initial response to treatment was observed in 83% of patients (n = 48), while the remaining 17% (n = 10) required further evaluation. All 10 patients for whom initial treatment failed (100%) had a diagnosis involving airway hyperreactivity (P < .001). In addition, chest radiography was more likely to be ordered (odds ratio [OR], 16.4; 95% CI, 1.91-140.8; P = .002) and to contain pertinent positive findings (OR, 12.8; 95% CI, 1.15-142.6; P = .04) in patients for whom treatment failed.
Conclusions And Relevance:
Chronic cough in the pediatric otolaryngology setting differs from the typical presentation in the primary care setting. The top 3 causes encountered by the practicing otolaryngologist in a pediatric patient are infection, airway hyperreactivity, and gastroesophageal reflux disease. If initial otolaryngologic treatment fails, chest radiography and early pulmonary consult are recommended.
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