Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach
Melanie Greifer1, Maria T Santiago2, Kalliope Tsirilakis2
1Hofstra North Shore LIJ School of Medicine, United States; Division of Gastroenterology and Nutrition, The Steven and Alexandra Cohen Children's Medical Center of New York, United States.
Insights
A multidisciplinary team approach successfully diagnosed nearly all patients with recurrent croup and chronic cough. This comprehensive evaluation identified airway abnormalities and esophagitis in a significant number of children.
Area of Science:
- Pediatric Pulmonology
- Pediatric Gastroenterology
- Pediatric Otolaryngology
Background:
- Recurrent croup and chronic cough in children present complex diagnostic challenges.
- A multidisciplinary approach may improve diagnostic yield for these conditions.
Purpose of the Study:
- To evaluate the effectiveness of a multidisciplinary team (Comprehensive Airway, Respiratory, and Esophageal - CARE Team) in managing recurrent croup and chronic cough.
- To identify common diagnoses, including airway abnormalities and esophagitis, in this patient population.
Main Methods:
- Retrospective chart review of patients with recurrent croup or chronic cough managed by the CARE Team.
- Inclusion criteria required a full workup: laryngoscopy, bronchoscopy, bronchoalveolar lavage (BAL), and upper endoscopy with biopsies.
- Patients were categorized based on esophageal biopsy results (esophagitis vs. normal) and compared for clinical features and airway findings.
Main Results:
- Forty patients met inclusion criteria; 53% had airway abnormalities (most common: tracheomalacia, enlarged adenoids).
- Esophagitis was diagnosed in 38% of patients; 27% of these had eosinophilic esophagitis.
- No significant differences were found in gastrointestinal complaints, abdominal pain, failure to thrive, or airway abnormalities between groups with and without esophagitis.
Conclusions:
- A multidisciplinary team approach is beneficial for diagnosing children with recurrent croup and chronic cough.
- The CARE Team achieved a specific diagnosis in nearly 95% of evaluated patients.
- Esophagitis, including eosinophilic esophagitis, is a notable finding in this cohort.
Objective:
To evaluate the results of our multidisciplinary approach to recurrent croup and chronic cough.
Methods:
Retrospective chart review of all patients with recurrent croup and chronic cough managed at a tertiary care children's hospital by our Comprehensive Airway, Respiratory, and Esophageal (CARE) Team. Charts were reviewed for all patients who carried a diagnosis of recurrent croup or chronic cough. Patients were excluded if they did not receive a full workup, including micro-direct laryngoscopy, flexible and/or rigid bronchoscopy, bronchioalveolar lavage (BAL), and upper endoscopy with biopsies. We reviewed the records for the presence of gastrointestinal complaints, abdominal pain and failure to thrive (FTT) and compared the children with documented esophagitis to the remaining children.
Results:
Forty patients met inclusion criteria. 53% had airway abnormalities; the most common was tracheomalacia, followed by enlarged adenoids. 38% had esophagitis (group 1) while 62% had normal esophageal biopsies (group 2). Among the children in group 1, 27% met criteria for eosinophilic esophagitis (>15 eosinophils per high powered field). There was no significant difference between groups 1 and 2 based on the presence of gastrointestinal complaints, abdominal pain and/or FTT (p>0.05). There was no significant difference between the groups based on the location or presence of an airway abnormality (p>0.05).
Conclusions:
Children with recurrent croup and chronic cough may benefit from a multidisciplinary approach to management. Our CARE Team approach led to a specific diagnosis in almost 95% of patients.
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