Evaluation of Chronic Cough Etiologies in Children

Öz

Objective: Cough is one of the leading causes of hospitalization in children worldwide. It should be considered important because it can be a symptom of various serious diseases and affects the quality of life of the child. A differential diagnosis should be performed on all children with a chronic cough. This study aimed to determine the etiologies in patients evaluated for chronic cough.

Material and Methods: The study included patients admitted to the pediatric immunology and allergy outpatient clinic, with the complaint of chronic cough between the ages of 0–18 years. Clinical and demographic characteristics of patients were recorded.

Results: This study included 323 patients between the ages of 0-18years. The median age of the patients was 7 (interquartile range: 5-9.7) years. One hundred and forty five (45%) of the patients were female. One hundred seventy-nine (55.4%) patients had a family history of atopic diseases such as asthma and/or allergic rhinitis. The presence of aeroallergen sensitivity was demonstrated in 127 patients. One hundred and forty-four (44.6%) patients were diagnosed with asthma, 75 (23.2%) patients with wheezing, 54 (16.7%) patients with post-infectious cough, 43 (13.3%) patients with postnasal drip syndrome, 4 (1.2%) patients with gastroesophageal reflux, 2 (0.6%) patients with foreign body aspiration, and 1 (0.3%) patient with psychogenic cough. Moreover, two patients with asthma, and one patient with wheezing had reflux symptoms in addition to the diagnosis of asthma and wheezing. One patient was found to have a partial IgA deficiency, and 18 patients had hypogammaglobulinemia. Immunoglobulin replacement therapy was initiated for a patient with hypogammaglobulinemia. Of the 219 patients diagnosed with asthma or wheezing, 144 had an atopic disease in the family (p<0.001). It was found that one hundred and eighty-five patients (57.3%) had domestic smoke exposure. Furthermore, smoke exposure was observed in 58 (77.3%) of 75 patients under the age of 6 years who were followed up with the diagnosis of wheezing (p= 0.010).

Conclusion: In our study, asthma, which is one of the most common causes of chronic cough in the literature, was found to be the most common cause. For a correct approach when making a differential diagnosis in pediatric patients presenting with chronic cough, the patient’s history, physical examination, laboratory tests, and risk factors should be evaluated as a whole with systematic evaluation.

Anahtar Kelimeler

• chronic cough
• child
• asthma
• wheezy infant

Çocuklarda Kronik Öksürük Sebeplerinin Değerlendirilmesi

Öz

Amaç: Öksürük, tüm dünyada çocukluk çağında en sık hastaneye başvuru sebeplerinden biridir. Çeşitli ciddi hastalıkların da belirtisi olabilmesi ve çocuğun hayat kalitesini etkilemesi nedeniyle önemsenmelidir. Tüm kronik öksürüğü olan çocuklar ayırıcı tanı açısından değerlendirilmelidir. Bu çalışmada kronik öksürük sebebiyle değerlendirilen hastalarda etyolojilerin belirlenmesi amaçlanmıştır.

Gereç ve Yöntemler: Çalışmaya çocuk immünoloji ve alerji polikliniğine 0-18 yaş aralığında kronik öksürük şikayeti ile başvuran hastalar dahil edildi. Hastaların klinik ve demografik bilgileri retrospektif olarak dosyalarından kayıt edildi.

Bulgular: Bu çalışmada 0-18 yaş aralığında 323 hasta yer almaktaydı.Hastaların yaş ortancası 7 yıl (çeyreklerarası aralık:5-9.7)’di. Hastaların 145’i (%45) kızdı. Yüzyetmişdokuz (%55.4) hastanın ailesinde atopik hastalık öyküsü vardı. Hastaların 127’sinde aeroalerjen duyarlılığının varlığı gösterildi. Yüzkırkdört (%44.6) hastaya astim, 75 (%23.2) hastaya hışıltılı çocuk, 54 (%16.7) hastaya postenfeksiyoz öksürük, 43 (%13.3) hastaya postnazal akıntı sendromu, 4(%1.2) hastaya reflü, 2 (%0.6) hastaya yabanci cisim aspirasyonu, 1 (%0.3) hastaya psikojenik öksürük tanısı konuldu. Ayrıca iki hastada astım, bir hastada ise hışıltılı çocuk tanısına ek olarak reflü semptomlarının olduğu görüldü.Bir hasta parsiyal IgA eksikliği, 18 hasta da hipogamaglobulinemi sebebiyle takibe alındı. Onsekiz hastanin birine ise immunoglobulin replasman tedavisi başlandi. Astım veya hışıltılı çocuk tanısı alan 219 hastanın 144’ünde aile de atopik bir hastalık olduğu öğrenildi (p<0.001). Yüzseksenbeş hastada (%57.3) ev içi sigara maruziyeti olduğu öğrenildi. Ayrıca 6 yaş altında hışıltılı çocuk tanısı ile takibe alınan 75 hastanın 58’inde (%77.3) sigara maruziyeti olduğu görüldü (p= 0.010).

Sonuç: Literatürde kronik öksürüğün en sık nedenleri içinde yer alan astım, bizim çalışmamızda da en sık sebep olarak saptanmıştır. Kronik öksürük ile başvuran çocuk hastalarda ayırıcı tanı yaparken, sistematik değerlendirme ile hastanın öykü, fizik muayene ve laboratuvar tetkikleri ile risk faktörleri bütün olarak değerlendirilmelidir.

Anahtar Kelimeler

• kronik öksürük
• çocuk
• astım
• hışıltılı çocuk

Kaynakça

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