| Cough is a key defense mechanism that clears the airways of foreign particles and internal materials, preventing aspiration and maintaining respiratory health. While typically essential for lung health, dysregulation of this reflex can lead to pathological conditions, adversely affecting daily life. Evaluating cough severity accurately is crucial for diagnosis and effective treatment. In children, this process is particularly complex due to their developing airways, immature immune systems, and heightened sensitivity to environmental factors. |
| Chronic Cough in Children |
| When cough is dysregulated, it can become chronic, leading to significant distress and increased healthcare utilization. Chronic cough is defined as lasting more than 8 weeks in adults and more than 4 weeks in children. This distinction reflects the unique characteristics of pediatric airways and their susceptibility to external irritants. |
| Differences in Pediatric Chronic Cough |
| Chronic cough in children differs significantly from that in adults due to developmental and physiological differences. Children’s airways are more vulnerable to noxious stimuli, their cough reflex is less regulated, and their neurological and immunological systems are still maturing. These factors make paediatric chronic cough a symptom often indicative of an underlying disease rather than an isolated condition. |
| Common Causes of Pediatric Chronic Cough |
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| Various systemic disorders |
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| Upper airway cough syndrome |
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| Protracted bacterial bronchitis |
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| Gastroesophageal reflux disease (GERD) |
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| In older children (≥14 years) and adults, additional factors like smoking and the use of ACE inhibitors can contribute to chronic cough. |
| Factors Influencing Chronic Cough |
| The presentation and persistence of chronic cough in children are influenced by factors such as age, gender, and exposure to indoor and outdoor air pollution. Additionally, the quality of healthcare systems plays a critical role in managing underlying diseases that may cause chronic cough. |
| Importance of Comprehensive Cough Assessment |
| There are subjective and objective methods for assessing cough. These methods help characterize the heterogeneity of cough phenotypes and may enhance treatment strategies by monitoring responses to nonpharmacological and pharmacological therapies. Clinical assessment should include tools that measure both the frequency and severity of cough, as advocated by the European Respiratory Society’s guidelines on cough evaluation. |
| Tools for Cough Assessment |
| To evaluate chronic cough in children, various subjective and objective tools are employed. These methods capture different aspects of the symptom, helping clinicians and researchers better understand and manage the condition. |
| Subjective Methods |
| Subjective Methods |
Description |
Limitations |
| Quality of Life (QoL) Questionnairesx` |
Assess the impact of chronic cough on quality of life. |
Parental perception for children may introduce bias, reflecting their views rather than the child’s experience. |
| Cough Quality of Life Questionnaire (CQLQ) |
Validated for adults and adolescents (self-reported). |
Limited applicability for younger children. |
| Leicester Cough Questionnaire (LCQ) |
validated QoL tool for adults and adolescents. |
Not suitable for younger pediatric populations. |
| Parent Cough-Specific QoL Questionnaire |
Reflects parental perception of how cough affects their child. |
Potential bias as it depends on parental interpretation rather than direct feedback from the child. |
| Cough Severity Scales |
Tools such as Visual Analogue Scale (VAS) and Numeric Rating Scale (NRS) to rate severity. |
Subjective in nature, relying on individual perception and reporting. |
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| Objective Methods |
| Method |
Description |
Limitations |
| Acoustic Cough Counting |
Measures cough frequency in all age groups. |
Does not reliably assess severity of the cough. |
| Tussigenic Challenges |
Inhalation tests to study cough mechanisms, primarily used in research settings. |
Limited evidence of reliability; not recommended as primary clinical outcome measures. |
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| Conclusion |
| Chronic cough in children is a multifaceted issue that requires a comprehensive evaluation approach. Subjective tools like QoL questionnaires and severity scales provide insight into the perceived impact of the cough, while objective methods like acoustic cough counting offer precise data on frequency. Understanding the underlying causes and employing tailored assessment tools can help improve the management of chronic cough in pediatric populations. |
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