Evaluation of Patients Presenting with Chronic Cough to the Pediatric Allergy Clinic According to Age Groups

Year 2025, Volume: 35 Issue: 1, 155 - 161, 28.02.2025

İrem Turgay Yağmur

https://doi.org/10.54005/geneltip.1582368

Abstract

Background/Aims: Chronic cough is a prevalent issue in pediatric patients and is among the most common reasons for referral to pediatric allergists, significantly affecting quality of life and often necessitating specialized evaluation. This study aimed to analyze the clinical characteristics, etiologies, and management of chronic cough in children, providing insights into age-related prevalence.
Methods: Pediatric patients presenting with chronic cough to our pediatric allergy clinic between May 1,2023 and May 31, 2024 were included in this retrospective study. Patients previously diagnosed with allergic diseases or evaluated at other clinics were excluded. Medical records were reviewed for demographics, cough characteristics, familial and environmental factors, and treatments.
Results: Of the 267 patients included, 54.7% were boys, and the median age was 6.99 (interquartile range (IQR) 4.47-11.54) years. Asthma (39%), protracted bacterial bronchitis (PBB) (25.8%), and upper airway cough syndrome (UACS) (22.1%) were the most common diagnoses. PBB was more prevalent in younger patients, whereas asthma was dominant in older age groups. Regardless of the cough etiology, antibiotic use was noted in 67.8% of patients before applying to the pediatric allergy outpatient clinic. Tobacco smoke exposure was present in 40.1% of patients. Familial asthma history was significantly more common in patients with asthma (p=0.04).
Conclusions: This study underscores the importance of distinguishing chronic cough etiologies in children to prevent mismanagement and overuse of antibiotics. While asthma, PBB, and UACS were among the primary causes, many other potential diagnoses also warrant consideration. Comprehensive assessments are essential for accurate diagnosis, and a multi-disciplinary approach may enhance management outcomes.

Keywords

asthma, chronic cough, upper airway cough syndrome, protracted bacterial bronchitis

Çocuk Alerji Polikliniği’ne Kronik Öksürük Nedeni ile Başvuran Hastaların Yaş Gruplarına Göre Değerlendirilmesi

Abstract

Amaç: Kronik öksürük pediatrik hastalarda sık görülen bir sorundur ve pediatrik alerjistlere başvurunun en sık nedenleri arasındadır. Çalışmamızda, çocuklarda kronik öksürüğün klinik özelliklerini, etiyolojilerini ve tedavi yönetimini analiz etmeyi ve yaşa göre prevalans farklılıklarına ilişkin bilgi sağlamayı amaçladık.
Gereç ve Yöntem: 1 Mayıs 2023 - 31 Mayıs 2024 tarihleri arasında kronik öksürük şikayetiyle pediatrik alerji polikliniğimize başvuran pediatrik hastalar retrospektif olarak taranarak çalışmaya dahil edildi. Önceden alerjik hastalık tanısı konulmuş veya başka bir çocuk alerji kliniğinde değerlendirilmiş olan hastalar çalışmaya dahil edilmedi. Tıbbi kayıtlardan hastaların demografik verileri, öksürük özellikleri, ailevi ve çevresel faktörler ile tedavileri değerlendirildi.
Bulgular: Çalışmaya 267 hasta dahil edildi. Hastaların %54,7’si erkek ve medyan yaşları 6,99 (IQR 4.47-11.54) yıl idi. Hastalara en sık astım (%39), uzamış bakteriyel bronşit (UBB) (%25,8) ve üst solunum yolu öksürük sendromu (ÜSYÖS) (%22,1) tanıları koyuldu. UBB, daha çok küçük yaştaki hastalarda görülürken, astım ise daha büyük yaş gruplarında baskın tanı idi. Öksürük etiyolojisinden bağımsız olarak, hastaların %67,8'i çocuk alerji polikliniğine başvurmadan önce antibiyotik kullanmıştı. Hastaların %40,1'inde tütün dumanı maruziyeti tespit edildi. Ailede astım öyküsü, astım tanısı alan hastalarda diğer tanılara göre anlamlı derecede daha yüksek bulundu (p=0.04).
Sonuç: Çocuklarda kronik öksürük etiyolojisinin doğru bir şekilde belirlenmesi, yanlış tedavi ve gereksiz antibiyotik kullanımını önlemek için önemlidir. Astım, UBB ve ÜSYÖS çocuklarda kronik öksürüğün başlıca nedenleri olup göz önünde bulundurulması gereken birçok başka potansiyel tanı bulunmaktadır. Doğru teşhis için kapsamlı değerlendirme ve multidisipliner yaklaşım önemlidir.

Keywords

astım, kronik öksürük, üst solunum yolu öksürük sendromu, uzamış bakteriyel bronşit

References

• 1. Chang AB, Oppenheimer JJ, Irwin RS; CHEST Expert Cough Panel. Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest. 2020;158(1):303-329. doi: 10.1016/j.chest.2020.01.042. PMID: 32179109.
• 2. Marchant JM, Newcombe PA, Juniper EF, Sheffield JK, Stathis SL, Chang AB. What is the burden of chronic cough for families? Chest. 2008;134(2):303-309. doi: 10.1378/chest.07-2236. PMID: 18641100.
• 3. Mukerji SS, Yenduri NJS, Chiou E, Moonnumakal SP, Bedwell JR. A multi-disciplinary approach to chronic cough in children. Laryngoscope Investig Otolaryngol. 2022;7(2):409-416. doi: 10.1002/lio2.778. PMID: 35434349; PMCID: PMC9008181.
• 4. Chang AB, Robertson CF, Van Asperen PP, Glasgow NJ, Mellis CM, Masters IB, Teoh L, Tjhung I, Morris PS, Petsky HL, Willis C, Landau LI. A multicenter study on chronic cough in children: burden and etiologies based on a standardized management pathway. Chest. 2012;142(4):943-950. doi: 10.1378/chest.11-2725. PMID: 22459773.
• 5. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S. doi: 10.1378/chest.129.1_suppl.260S. PMID: 16428719.
• 6. Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, Hilton Boon M, Kantar A, Lai K, McGarvey L, Rigau D, Satia I, Smith J, Song WJ, Tonia T, van den Berg JWK, van Manen MJG, Zacharasiewicz A. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;55(1):1901136. Doi: 10.1183/13993003.01136-2019. PMID: 31515408; PMCID: PMC6942543.
• 7. Kantar A, Chang AB, Shields MD, Marchant JM, Grimwood K, Grigg J, Priftis KN, Cutrera R, Midulla F, Brand PLP, Everard ML. ERS statement on protracted bacterial bronchitis in children. Eur Respir J. 2017;50(2):1602139. Doi: 10.1183/13993003.02139-2016. PMID: 28838975.
• 8. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UBS, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):1S-23S. doi: 10.1378/chest.129.1_suppl.1S. PMID: 16428686; PMCID: PMC3345522.
• 9. Asilsoy S, Bayram E, Agin H, Apa H, Can D, Gulle S, Altinoz S. Evaluation of chronic cough in children. Chest. 2008;134(6):1122-1128. doi: 10.1378/chest.08-0885. PMID: 18689594.
• 10. Karabel M, Kelekçi S, Karabel D, Gürkan MF. The evaluation of children with prolonged cough accompanied by American College of Chest Physicians guidelines. Clin Respir J. 2014;8(2):152-9. doi: 10.1111/crj.12052. PMID: 23981451.
• 11. Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, Uzuner S, Nursoy M, Ozkaya E, Aksoy F, Gokce S, Bahali K. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr. 2015;41:73. Doi: 10.1186/s13052-015-0180-0. PMID: 26444536; PMCID: PMC4595107.
• 12. Topal OY. Evaluation of Chronic Cough Etiologies in Children. Türkiye Çocuk Hast Derg. 2023;17(3):227-32. doi: 10.12956/tchd.1216596.
• 13. Ozsezen B. Evaluation of Patients with Chronic Cough Referred to Pediatric Pulmonology Outpatient Clinic. Türkiye Çocuk Hast Derg 17(1):62.7. Doi: 10.12956/tchd.1205598.
• 14. Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough. Chest. 2006;129(5):1132-41. doi: 10.1378/chest.129.5.1132. PMID: 16685002.
• 15. Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, Masters IB, Teoh L, Mellis CM, Landau LI, Marchant JM, Morris PS. A cough algorithm for chronic cough in children: a multicenter, randomized controlled study. Pediatrics. 2013;131(5):e1576-83. doi: 10.1542/peds.2012-3318. PMID: 23610200.
• 16. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995;332(3):133-8. doi: 10.1056/NEJM199501193320301. PMID: 7800004.
• 17. Di Filippo P, Scaparrotta A, Petrosino MI, Attanasi M, Di Pillo S, Chiarelli F, Mohn A. An underestimated cause of chronic cough: The Protracted Bacterial Bronchitis. Ann Thorac Med. 2018;13(1):7-13. doi: 10.4103/atm.ATM_12_17. PMID: 29387250; PMCID: PMC5772114.
• 18. Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, Irwin RS; CHEST Expert Cough Panel. Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. Chest. 2017;151(4):884-890. doi: 10.1016/j.chest.2017.01.025. PMID: 28143696.
• 19. Chang AB, Upham JW, Masters IB, Redding GR, Gibson PG, Marchant JM, Grimwood K. Protracted bacterial bronchitis: The last decade and the road ahead. Pediatr Pulmonol. 2016;51(3):225-42. doi: 10.1002/ppul.23351. PMID: 26636654; PMCID: PMC7167774.
• 20. Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease, and bronchiectasis. Pediatr Pulmonol. 2008;43(6):519-31. doi: 10.1002/ppul.20821. PMID: 18435475.
• 21. Chang AB, Marchant JM. Protracted bacterial bronchitis is a precursor for bronchiectasis in children: myth or maxim? Breathe (Sheff). 2019;15(3):167-170. doi: 10.1183/20734735.0178-2019. PMID: 31508153; PMCID: PMC6717611.
• 22. Wurzel DF, Marchant JM, Yerkovich ST, Upham JW, Petsky HL, Smith-Vaughan H, Masters B, Buntain H, Chang AB. Protracted Bacterial Bronchitis in Children: Natural History and Risk Factors for Bronchiectasis. Chest. 2016;150(5):1101-1108. doi: 10.1016/j.chest.2016.06.030. PMID: 27400908.
• 23. Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):63S-71S. doi: 10.1378/chest.129.1_suppl.63S. PMID: 16428694.
• 24. Gao F, Gu QL, Jiang ZD. Upper airway cough syndrome in 103 children. Chin Med J (Engl). 2019;132(6):653-8. doi: 10.1097/CM9.0000000000000118. PMID: 30855345; PMCID: PMC6416099.
• 25. Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012;129(4):735-44. doi: 10.1542/peds.2011-2196. PMID: 22430451.
• 26. Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res. 2011;12(1):5. doi: 10.1186/1465-9921-12-5. PMID: 21219618; PMCID: PMC3022703.
• 27. Gibson PG, Chang AB, Glasgow NJ, Holmes PW, Katelaris P, Kemp AS, Landau LI, Mazzone S, Newcombe P, Van Asperen P, Vertigan AE; CICADA. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian cough guidelines summary statement. Med J Aust. 2010;192(5):265-71. doi: 10.5694/j.1326-5377.2010.tb03504.x. PMID: 20201760.