HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

Electronic Letters to:

COUGH: Julie M. Marchant, I. Brent Masters, Simone M. Taylor, Nancy C. Cox, Greg J. Seymour, and Anne B. Chang Evaluation and Outcome of Young Children With Chronic Cough Chest 2006; 129: 1132-1141 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Cough in Children: Look Up Rather than Down

Roger Menendez   (1 June 2006)

Cough in Children: Look Up Rather than Down 1 June 2006
Roger Menendez, Physician Allergy and Asthma Center of El Paso Send letter to journal: Re: Cough in Children: Look Up Rather than Down rmaacep{at}swbell.net Roger Menendez	I find the author's approach to the diagnosis of chronic cough in children very disturbing. The majority of their patients (89%) had "wet"- meaning, productive- cough, a finding that in our 19 year experience is associated with sinusitis in over 80% of cases and prompts us to order CT evaluation of the paranasal sinuses, rather than sujbecting these children to invasive, unnecessary procedures such as bronchoscopy. It appears that the authors did not even consider subacute or chronic sinusitis as part of their differential diagnoses. That the majority of their subjects were indeed probably coughing as a result of sinusitis is further supported by the presence of neutrophilia in both induced sputum and BAL fluid. Similarly, in our experience, these patients also have marked neutrophilia of aspirated nasopharyngeal secretions. In fact, the association of wet, productive cough in children with abnormal CT scans of the paranasal sinuses is so stricking that we have opted to refer to this symptom complex as the "sinobronchial syndrome". Treatment of the "protracted bacterial bronchitis" with 2 week courses of antibiotics would, of course, be effective in resolving the sinus infection in at least 80% of those children, with the rest requiring longer therapy. In our 19 year experience, we have never had to refer any of these children for sinus surgery unless their course was complicated by suppurative adenoiditis or massive polyposis. The mechanism by which bacterial sinusitis can lead to lower respiratory tract symptoms is not clearly understood but may include aspiration of infected post-nasal drip and release of inflammatory and neutrophil-chemoattractant cytokines into the airways. The former mechanism is particularly attractive when explaining the frequency with which chest auscultatory findings predominate over the right lower lobe as compared to the left lung and by the frequent finding of right lung peribronchial infiltrates. I believe the authors are doing a disservice to the pediatric community by not including evaluation of the paranasal sinuses in any child presenting with chronic productive cough. R. Menendez, MD, FCCP