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Diagnosis in Children With Prolonged or Recurrent Cough: Findings From the Swiss Paediatric Airway Cohort
Maria Christina Mallet1,2, Annina Elmiger1, Sarah Glick1
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Insights
Asthma is a common cause of prolonged cough in schoolchildren, while respiratory infections are more frequent in preschoolers. Comprehensive diagnosis is crucial for children with persistent cough.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Prolonged or recurrent cough is a frequent pediatric referral reason.
- Limited research exists on the specific causes of chronic cough in children.
- Understanding age-related diagnostic patterns is essential for effective management.
Purpose of the Study:
- To investigate the spectrum of diagnoses for prolonged or recurrent cough in children.
- To analyze how diagnoses differ based on age groups (preschoolers vs. schoolchildren).
- To evaluate the diagnostic approaches and treatments in a pediatric respiratory outpatient setting.
Main Methods:
- Analysis of data from the multicenter Swiss Paediatric Airway Cohort study.
- Inclusion of 363 children (aged 0-16 years) with prolonged or recurrent cough.
- Extraction of diagnostic investigations, final diagnoses, and prescribed treatments from outpatient records.
Main Results:
- Asthma and related conditions were diagnosed in 36% of children.
- Respiratory tract infections (RTIs), including protracted bacterial bronchitis (PBB), were diagnosed in 14%.
- Upper airway cough syndrome (UACS) affected 13%, postinfectious cough 10%, and no etiology found in 20%.
Conclusions:
- Diagnoses for pediatric cough vary significantly between preschool and school-aged children.
- Asthma is a major diagnosis (36%), highlighting the need for investigations beyond asthma.
- Age-specific diagnostic patterns necessitate tailored clinical approaches for pediatric cough.
Introduction:
Prolonged or recurrent cough is a common reason for referral to pediatric pulmonologists, yet few studies have assessed its causes. We examined records of children visiting respiratory outpatient clinics in Switzerland and assessed how diagnoses vary by age.
Methods:
We analyzed data from the multicenter Swiss Paediatric Airway Cohort study. We included 363 children (median age 6 years, range 0-16) referred for prolonged or recurrent cough. From outpatient records, we extracted information on diagnostic investigations, final diagnoses proposed by pediatric pulmonologists, and treatments prescribed.
Results:
Asthma and asthma-like conditions (cough variant asthma, episodic viral wheeze, and recurrent obstructive bronchitis) were diagnosed in 132 (36%) of 363 children, respiratory tract infections (RTI) including protracted bacterial bronchitis (PBB) in 51 (14%), upper airway cough syndrome (UACS) in 48 (13%), and postinfectious cough in 36 (10%); other diagnoses including gastroesophageal reflux disease (GERD) and somatic cough syndrome or tic cough were found in 23 (6%). No etiology was found in 73 children (20%). Asthma was diagnosed 3.5 times more often in schoolchildren while RTI including PBB was diagnosed three times more often in preschoolers. Inhaled corticosteroids were prescribed for 84% of children diagnosed with asthma and asthma-like conditions, antibiotics for 43% of children with RTI, and nasal corticosteroids for 83% of those with UACS.
Conclusion:
Coughing children received a wide spectrum of diagnoses that differed between preschool and schoolchildren. Asthma accounted for 36% of diagnoses, which emphasizes the importance of comprehensive investigation beyond asthma in children with prolonged or recurrent cough.
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