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Wet Cough and Nasal Symptoms in Children: Can We Do Better?
Fernando M de Benedictis1, Ines Carloni2, Pasquale Comberiati3
1Salesi Children's Hospital Foundation, Ancona, Italy.
Insights
Chronic cough in children often stems from protracted bacterial bronchitis or Upper Airway Cough Syndrome (UACS). Early diagnosis and treatment are crucial, but further research is needed to differentiate causes and optimize interventions, potentially reducing antibiotic use.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Infectious Diseases
Background:
- Chronic cough is a common pediatric issue with varied causes.
- Protracted bacterial bronchitis requires prompt antibiotic treatment to prevent complications like bronchiectasis.
- Upper Airway Cough Syndrome (UACS) is a potential contributor to chronic cough in children.
Purpose of the Study:
- To explore the diverse etiologies of chronic cough in pediatric populations.
- To evaluate the diagnostic criteria and treatment efficacy for conditions like protracted bacterial bronchitis and UACS.
- To emphasize the need for judicious antibiotic use and further research into wet cough in children.
Main Methods:
- Review of existing literature on pediatric chronic cough.
- Analysis of clinical criteria for diagnosing UACS.
- Discussion of the role of nasal endoscopy and saline irrigation in UACS management.
Main Results:
- Protracted bacterial bronchitis is a significant cause of pediatric morbidity, responsive to antibiotics.
- UACS diagnosis relies on sensitive but non-specific clinical signs.
- Efficacy data for nasal saline irrigation in UACS are limited, with methodological biases in current studies.
Conclusions:
- Accurate diagnosis of chronic wet cough in children is essential to avoid misattributing it to lower airway disease.
- Further randomized controlled trials are needed to establish the efficacy of interventions like nasal saline irrigation for UACS.
- Reducing reliance on oral antibiotics for certain types of wet cough could help mitigate antibiotic resistance.
Abstract:
The causes of chronic cough in children are mainly dependent on the setting and age of the child. Protracted bacterial bronchitis is a frequent cause of morbidity in childhood, and antibiotic treatment is beneficial. Prompt recognition and early treatment is important both to prevent inappropriate use of asthma medications and also progression to bronchiectasis, but the diagnosis should not be made uncritically, because chronic wet cough is not necessarily due to lower airway disease. Upper Airway Cough Syndrome (UACS) is considered by some to cause chronic cough in childhood. Underlying UACS are many common conditions, including allergic rhinitis, adenoiditis and rhinosinusitis. Diagnosis relies on a combination of clinical criteria that are relatively sensitive but non-specific. The role of nasal endoscopy in children with chronic cough and signs suggesting UACS is unclear. Nasal saline solution irrigation is commonly used in UACS, but most studies have methodological biases, and efficacy data are scanty. Randomized controlled trials are urgently required. However, if saline washes, rather than oral antibiotics, can effectively treat some children with wet cough associated with upper airway conditions, antibiotic resistance could potentially be reduced. There is a need to further study wet cough and not to assume it to be equivalent to lower airway infection in all children.
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