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* From the Department of Respiratory Medicine (Drs. Marchant, Masters, Chang and Ms. Taylor), Royal Children’s Hospital, Brisbane, QLD, Australia; the Department of Cytology (Ms. Cox), Royal Brisbane Hospital, Brisbane, QLD, Australia; and the Department of Dentistry (Dr. Seymour), University of Queensland, Brisbane, QLD, Australia.
Correspondence to: Julie Marchant, Department of Respiratory Medicine, Royal Children’s Hospital, Herston 4029, QLD, Australia; e-mail: Julie_Marchant{at}health.qld.gov.au
Abstract
Objective: To evaluate the use of an adult-based algorithmic approach to chronic cough in a cohort of children with a history of > 3 weeks of cough and to describe the etiology of chronic cough in this cohort.
Methods: A prospective cohort study of children referred to a tertiary hospital with a history of > 3 weeks of cough between June 2002 and June 2004. All included children followed a pathway of investigation (including flexible bronchoscopy and evaluation of airway cytology via BAL) until diagnosis was made and/or their cough resolved.
Results: In our cohort of 108 young children (median age 2.6 years), the majority had wet cough (n = 96; 89%), and BAL fluid samples obtained during bronchoscopy led to a diagnosis in 45.4% (n = 49). The most common final diagnosis was protracted bacterial bronchitis (n = 43; 39.8%). These patients had neutrophil levels on BAL samples that were significantly higher than those in other diagnostic groups (p < 0.0001). Asthma, gastroesophageal reflux disease (GERD), and upper airway cough syndrome (UACS), which are common causes of chronic cough in adults, were found in < 10% of the cohort (n = 10).
Conclusions: The adult-based anatomic pathway, which involves the investigation and treatment of patients with asthma, GERD, and UACS first is largely unsuitable for use in the management of chronic cough in young children as the common etiologies of chronic cough in children are different from those in adults.
Key Words: airway inflammation • BAL • bronchitis • chronic cough • children • etiology • investigation • management
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