Step by step approach helps chronic cough in kids

Public health

By Mardi Chapman

30 Oct 2019

A chronic cough management algorithm has been shown to improve cough resolution in children presenting to primary care or hospital emergency departments.

The Australian findings support previous evidence for the systematic approach in children presenting to specialist respiratory clinics.

The current study, published in Lancet Child & Adolescent Health, randomised 115 children from a larger cohort to either the intervention delivered by a paediatrician or a control group of watchful waiting.

The study group, aged <15 years and who had been coughing for at least 28 days, included a high proportion of Indigenous children (39%).

Cough was resolved by day 56 in 58% of children who received the intervention compared to 40% in the control group.

The study authors, from the Centre for Children’s Health Research, Brisbane, found the odds ratio of cough resolving in the intervention group was 1.5 on an intention-to-treat basis and 1.7 on a per-protocol basis.

The predominant causes of chronic cough were protracted bacterial bronchitis and asthma.

“These conditions are identified rapidly in the cough management algorithms and so immediate and appropriate management are likely to have contributed to the observed effectiveness in children with established chronic cough.”

“Prompt management of these conditions reduces the cough duration and improves QoL and is therefore clinically important,” the study said.

Lead author Dr Kerry-Ann O’Grady, a senior research fellow in public health at the Queensland University of Technology’s Institute of Health Biomedical Innovation, told the limbic cough was widely misdiagnosed.

“It’s a complicated condition to deal with particularly in younger children as a cough can be misdiagnosed as asthma when it’s not asthma and asthma can be overlooked as well,” she said.

A systematic assessment that rules out the key pointers for various types of cough helps ensures the children receive the appropriate follow-up and investigations.

“As you can see from that paper and others that we have done on the transition from acute to chronic illness, the majority of these kids, especially if they have not got a major history, are going to end up having protracted bacterial bronchitis which resolves quickly if appropriately managed with a couple of weeks of antibiotics.”

“The aim is to get people to identify these pointers early and get children treated early before it sets them up for these recurrent episodes which send them down the pathway to chronic lung disease.”

“Recurrent episodes of wet cough are a key predictor for bronchiectasis down the track and we know a lot of Indigenous children are at risk from a whole range of adverse respiratory outcomes.”

An accompanying Comment by speech pathologist and cough expert Dr Anne Vertigan, from the John Hunter Hospital in Newcastle, said the importance of cough in the health-care system can be under-recognised.

“The potential for developing chronic cough should be considered during the acute phase and interventions for cough in this phase, including behavioural and pharmaceutical, need to be developed.”

“In fact, targeting cough suppression in earlier phases simultaneously with addressing the underlying cause of the cough might be economical.”

“Although a need to treat chronic cough exists, the imperative to prevent chronic cough from developing is greater,” she said.

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