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Evaluation of children with chronic cough including obstructive sleep apnea: a single-center experience

Nisa Eda Cullas Ilarslan¹, Fatih Gunay², Zehra Sule Haskologlu³

¹Department of Pediatrics, Ankara University School of Medicine, Cebeci Hospital, Mamak, 06590, Ankara, Turkey. md.eda@hotmail.com.

European Journal of Pediatrics

|November 2, 2018

Insights

Asthma and protracted bacterial bronchitis (PBB) are common causes of chronic cough in children. Early intervention for non-specific cough, especially with high parental anxiety, improves resolution rates, and obstructive sleep apnea (OSA) may be an underdiagnosed cause.

Area of Science:

Pediatric Pulmonology
Sleep Medicine
Respiratory Medicine

Background:

Chronic cough in children presents diverse etiologies, necessitating accurate diagnosis and treatment.
Obstructive sleep apnea (OSA), a known cause in adults, has been under-evaluated in pediatric chronic cough.

Purpose of the Study:

To evaluate children with chronic cough using a standardized algorithm.
To assess obstructive sleep apnea (OSA) as a potential cause of chronic cough in children.
To compare cough resolution rates between two treatment protocols for non-specific cough.

Main Methods:

A cohort of 237 children with chronic cough was assessed for various etiologies.
Children with non-specific cough were randomized into early or delayed treatment groups.
Obstructive sleep apnea (OSA) was evaluated using the pediatric sleep questionnaire and polysomnography.

Main Results:

Asthma (82) and protracted bacterial bronchitis (PBB) (73) were the most frequent diagnoses.
Early treatment of non-specific cough yielded a 100% resolution rate versus 50% for delayed treatment.
Polysomnography identified mild, moderate, or severe OSA in 18 children, primarily linked to adenoid/adenotonsillary hypertrophy.

Conclusions:

Asthma and PBB are leading causes of chronic cough in the studied pediatric cohort.
Early treatment for non-specific cough may be beneficial, particularly in cases with high parental anxiety.
Further research with larger cohorts is recommended to integrate OSA assessment into standardized chronic cough diagnostic algorithms.

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Abstract:

Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? • Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. • Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? • We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. • We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.

Keywords:

Asthma Children Chronic cough Obstructive sleep apnea Protracted bacterial bronchitis

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