Chronic Cough: A neglected area in pediatric clinical practice

Year 2018, Volume: 45 Issue: 3, 229 - 335, 05.09.2018

Ali Özdemir

https://doi.org/10.5798/dicletip.457227

Abstract

Objective:
Cough is one of the most common but usually neglected complaint in pediatric
clinical practice. We aimed to explore the knowledge, attitude and clinical
practice among general pediatricians on chronic cough management.

Methods:
Data were prepared as questionnaires that had been developed by cough
guidelines in the literature.  Results:
Among 109 general pediatricians, a total of 88 (80,7%) participated into the
study; 43.2 % were female and the mean age was 42.01±7.89 yrs. The response for
the definition of chronic cough ranged from 2 weeks to 6 months. Of the
participants, 45.4% stated that they frequently evaluated children with chronic
cough. The majority (79.5%) sought consultation from one to four discrete
specialties. The most frequently ordered two tests were chest radiography
(88.6%) and complete blood count (30.7%). The majority of pediatricians
prescribed antibiotics (95.5%), antitussives (67.0%), expectorants (77.3%),
anti-histamines (62.5%) and empiric anti-reflux medications (69.3%) to children
with chronic cough. Most commonly prescribed antibiotic was macrolides (95.5%).
Among pediatricians, only 12.5% questioned passive smoking exposure and rarely
advised professional counseling against smoking to parents (55.6%).Overall,
66.0% of pediatricians agreed that they did not feel fully satisfied in the
management of chronic cough in children. All supported the preparation of a
national guideline and were willing for postgraduate education on chronic cough
management. 

Conclusions:
This study emphasizes the pediatricians’ lack of knowledge on chronic cough
management in children. Education is crucially important on chronic cough
management among general pediatricians which possibly decrease the differences
in personal practice.  

Keywords

Children, chronic cough

References

• 1. French CL, Irwin RS, Curley FJ, et al. Impact of chronic cough on quality of life. Arch Intern Med. 1998; 158: 1657-61.
• 2. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129 (suppl 1): 1S–23S.
• 3. Cornford CS, Morgan M, Ridsable L. Why do mothers consult when their children cough? Fam Pract. 1993; 10: 193-6.
• 4. Marchant JM, Newcombe PA, Juniper EF, et al. What is the burden of chronic cough for families? Chest. 2008; 134: 303-9.
• 5. Young EC, Smith JA. Quality of life in patients with chronic cough. Ther Adv Respir Dis. 2010; 4: 49–55.
• 6. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129: 260-83.
• 7. Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008; 63 Suppl 3: iii1-iii15.
• 8. Irwin RS. Introduction to the diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006; 129: 25S–27S.
• 9. Roca I, Akova M, Baquero F, et al. The global threat of antimicrobial resistance: science for intervention New Microbes New Infect. 2015; 16: 22-9.
• 10. D'Urzo A, Jugovic P. Chronic cough. Three most common causes. Can Fam Physician. 2002; 48: 1311-6.
• 11. Brand PL, Duiverman EJ. Coughing and wheezing children: improvement after parents stop smoking. Ned Tijdschr Geneeskd. 1998; 142: 825-7.
• 12. Cook DG, Strachan DP. Health effects of passive smoking—10: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999; 54: 357–66.
• 13. Elliot JG, Carroll NG, James AL, et al. Airway alveolar attachment points and exposure to cigarette smoke in utero. Am J Respir Crit Care Med. 2003; 167: 45–9
• 14. Brand PL, Duiverman EJ. Coughing and wheezing children: improvement after parents stop smoking. Ned Tijdschr Geneeskd. 1998; 142: 825-7.
• 15. T.C. Sağlık Bakanlığı. Havanı koru. Dumansız hava sahası (Republic of Turkey, Ministry of Health. Save your weather. The weather without smoke) Available via Google http://havanikoru.org.tr/yasa-hakkinda/14207-sayili-yasaya-kisaca-goz-atalim.html. Asscessed 4 July 2015.
• 16. T.C SağlıkBakanlığı. Tütün ve sigarayla mücadele kampanyası (Rebublic of Turkey Ministry of Health. The fight against tobacco and smoking campaign Accessed Available via Google http://www.saglik.gov.tr/SGGM/belge/115738/kampanya-hakkinda.htmlHovell. Accessed 4July 2015. 17. Asilsoy S, Bayram E, Agin H, et al. Evaluation of chronic cough in children. Chest. 2008; 134: 1122-8.
• 18. Marchant JM, Masters IB, Taylor SM, et al. Evaluation and outcome of young children with chronic cough. Chest. 2006; 129: 1132-41.
• 19. Usta Guc B, Asilsoy S, Durmaz C. The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: descriptive, prospective, clinical trial. Clin Respir J. 2014; 8: 330-7.