Characteristics of pediatric patients with chronic cough: data from a pediatric immunology and allergy outpatient clinic

Year 2025, Volume: 8 Issue: 1, 75 - 79, 12.01.2025

Hilal Ünsal , Beyza Ertürk

https://doi.org/10.32322/jhsm.1567695

Abstract

Aims: Chronic cough is a common complaint in childhood. A differential diagnosis is very important in children with a chronic cough. We aimed to investigate the etiology and underlying risk factors of chronic cough in children.
Methods: Patients aged 1-18 years who were referred to Sincan Training and Research Hospital Pediatric Immunology and Allergy Outpatient Clinic were included. Demographic, clinical and laboratory features of patients were recorded.
Results: The study included 403 children with a median age of 8 years (IQR 6-12) (53% males). 30% of patients had allergic rhinitis (AR), 4.7% of patients had atopic dermatitis (AD), and 2% patients had food allergy (FA) history. 78(19.3%) patients also complained of dyspnea and 9 (2.2%) patients had a diagnosis of cardiovascular disease. 245 (60.8%) asthma-wheezy infant, 107 (26.6%) post-infectious cough, 36 (9%) postnasal drip syndrome, 9 (2.2%) gastroesophageal reflux and 6 (1.5%) psychogenic cough were detected in the whole group. The number of patients with accompanying dyspnea 76 (28.5%) and familial history of atopy 113 (42.3%) were higher in the asthma-wheezy infant group than others group (p<0.001 vs. p<0.001). Skin prick tests were performed in 273 patients and the presence of aeroallergen sensitivity was shown in 122 (30.2%) patients. Immunoglobulin deficiency was detected in 43 (10.7%) patients. Serum IgG, IgA, and IgM levels were low in 26 (6.5%), 18 (4.4%), and 12 (3%) patients, respectively.
Conclusion: We found the most common reasons are asthma and post-infectious cough in patients. Chronic cough can be the first symptom of primary immunodeficiency diseases and systemic diseases. A detailed history is necessary to avoid unnecessary procedures, treatments and to avoid delay in diagnosis.

Keywords

Asthma, chronic cough, children, immunoglobulin

Ethical Statement

The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethics committee approval was obtained for this retrospective study (Decision number: 2024-BÇEK/150)

Kronik öksürüğü olan pediatrik hastaların özellikleri: pediatrik immünoloji ve alerji polikliniğinden alınan veriler

Abstract

Amaç: Kronik öksürük çocukluk çağında sık görülen bir şikayettir. Kronik öksürüğü olan çocuklarda ayırıcı tanı çok önemlidir. Çocuklarda kronik öksürüğün etiyolojisini ve altta yatan risk faktörlerini araştırmayı amaçladık.
Yöntemler: Sincan Eğitim ve Araştırma Hastanesi Çocuk İmmünoloji ve Alerji Polikliniğine sevk edilen 1-18 yaş arası hastalar çalışmaya dahil edildi. Hastaların demografik, klinik ve laboratuvar özellikleri kaydedildi.
Sonuçlar: Çalışmaya ortanca yaşı 8 yıl (IQR 6-12) olan 403 çocuk dahil edildi (%53 erkek). Hastaların %30'unda alerjik rinit (AR), %4,7'sinde atopik dermatit (AD) ve %2'sinde gıda alerjisi (FA) öyküsü vardı. 78 (%19,3) hastada ayrıca dispne şikayeti vardı ve 9 (%2,2) hastada kardiyovasküler hastalık tanısı vardı. Tüm grupta 245 (%60,8) astım-hırıltılı bebek, 107 (%26,6) postenfeksiyöz öksürük, 36 (%9) postnazal damla sendromu, 9 (%2,2) gastroözofageal reflü ve 6 (%1,5) psikojenik öksürük tespit edildi. Eşlik eden dispnesi olan hasta sayısı 76 (%28,5) ve ailede atopi öyküsü olan hasta sayısı 113 (%42,3) astım-hırıltılı bebek grubunda diğer gruplardan daha fazlaydı (p<0,001 vs. p<0,001). 273 hastaya deri prick testi yapıldı ve 122 (%30,2) hastada aeroalerjen duyarlılığı varlığı gösterildi. 43 (%10,7) hastada immünglobulin eksikliği tespit edildi. Serum IgG, IgA ve IgM düzeyleri sırasıyla 26 (%6,5), 18 (%4,4) ve 12 (%3) hastada düşüktü.
Sonuç: Hastalarda en sık görülen nedenlerin astım ve enfeksiyon sonrası öksürük olduğunu bulduk. Kronik öksürük, primer immün yetmezlik hastalıkları ve sistemik hastalıkların ilk belirtisi olabilir. Gereksiz prosedürlerden, tedavilerden kaçınmak ve tanıda gecikmeyi önlemek için ayrıntılı bir öykü gereklidir.

Keywords

Astım, kronik öksürük, çocuklar, immünoglobulin

References

• Peek R, Walker L, Singleton R. Chronic cough in preschool aged children. BMJ. 2024;386:e079747. doi:10.1136/bmj-2024-079747
• Marchant JM, Chang AB, Kennedy E, et al. Cough in Children and Adults: Diagnosis and Assessment (CICADA). Summary of an updated position statement on chronic cough in Australia. Med J Australia. 2024;220(1):35-45.
• Morice AH, Millqvist E, Bieksiene K, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020;56(5):1951136.
• Sonoda K, Nayak R. Chronic cough: evaluation and management. Am Family Physic. 2024;110(2):167-173.
• Cash H, Trosman S, Abelson T, Yellon R, Anne S. Chronic cough in children. JAMA Otolaryngol Head Neck Surg. 2015;141(5):417-423.
• De Jongste J, Shields M. Cough• 2: chronic cough in children. Thorax. 2003;58(11):998-1003.
• Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough. Chest. 2006;129(5):1132-1141.
• Asilsoy S, Bayram E, Agin H, et al. Evaluation of chronic cough in children. Chest. 2008;134(6):1122-1128.
• Chang AB, Oppenheimer JJ, Weinberger MM, et al. Use of management pathways or algorithms in children with chronic cough: CHEST guideline and expert panel report. Chest. 2017; 151(4):875-883.
• Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70-e88. doi:10.1164/rccm.201908-1590ST
• Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014; 70(2):338-351.
• Bousquet J, Schünemann HJ, Togias A, et al. Next-generation allergic rhinitis and its impact on asthma (ARIA) guidelines for allergic rhinitis based on grading of recommendations assessment, development and evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol. 2020;145(1):70-80.
• Global Strategy for Asthma Management and Prevention (Accessed September 1, 2020) Available from: https://ginasthma.org/wp-content/uploads/2020/06/GINA-2020-report_20_06_ 04-1-wms.pdf
• Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):260S-283S.
• Tezcan I, Berkel A, Ersoy F, Sanal O. Sağlıklı Türk çocukları ve erişkinlerde turbidometrik yöntemle bakılan serum immunoglobulin düzeyleri. Çocuk Sağ Hast Derg. 1996;39(56): 649.
• Tangye SG, Al-Herz W, Bousfiha A, et al. Human inborn errors of immunity: 2022 update on the classification from the international union of immunological societies expert committee. J Clin Immunol. 2022;42(7):1473-1507.
• Ünsal H, Şahiner ÜM, Soyer OU, Şekerel BE. Cupressus arizonica: an emerging aeroallergen for East Mediterranean children. Turk J Med Sci. 2023;53(5):1262-1270.
• Cavkaytar O, Buyuktiryaki B, Sag E, Soyer O, Sekerel BE. What we miss if standard panel is used for skin prick testing? Asian Pac J Allergy Immunol. 2015;33(3):211-221. doi:10.12932/AP0564. 33.3.2015
• Chang AB, Landau LI, Van Asperen PP, et al. Cough in children: definitions and clinical evaluation. Med J Aust. 2006;184(8):398-403.
• Singh D, Arora V, Sobti PC. Chronic/recurrent cough in rural children in Ludhiana, Punjab. Indian Pediatr. 2002;39(1):23-29.
• Zheng K, Tang L, Wang X, Chen L, Zhao Y, Chen X. The risk factors for chronic cough in children: a meta-analysis covering five continents. Respir Med. 2024;232:107752.
• Weinberger M. Chronic cough and causes in children. MDPI. 2023:3947.
• Tian C, Xiong S, Li S, et al. Spirometry in the diagnosis of cough variant asthma in children. Pediatr Pulmonol. 2024;59(2):291-299.
• Ng MC, How CH. Recurrent wheeze and cough in young children: is it asthma? Singapore Med J. 2014;55(5):236-241. doi: 10.11622/smedj.2014064
• Castro-Rodriguez JA. The asthma predictive index: early diagnosis of asthma. Curr Opin Allergy Clin Immunol. 2011;11(3): 157-161. doi:10.1097/ACI.0b013e3283464c4a
• Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study. Fam Pract. 2003;20(6):696-705.
• Ramanuja S, Kelkar PS. The approach to pediatric cough. Ann Allergy Asthma Immunol. 2010;105(1):3-8.
• Irwin RS. Introduction to the diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):25S-27S.
• Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. 2008;371(9621):1364-1374.
• Jesenak M, Banovcin P, Jesenakova B, Babusikova E. Pulmonary manifestations of primary immunodeficiency disorders in children. Front Pediatr. 2014;2:77.
• Kilic SS, Ozel M, Hafizoglu D, Karaca NE, Aksu G, Kutukculer N. The prevalances and patient characteristics of primary immunodeficiency diseases in Turkiye-two centers study. J Clin Immunol. 2013;33(1):74-83.