The interrelationships of upper and lower respiratory tract symptoms and signs in seven-year-old children.

Abstract

In 1968 the parents of all the 8, 683 children born in Tasmania in 1961 were asked to complete a detailed questionnaire on respiratory symptoms for these children. Satisfactory replies were received for 97 per cent (8, 410), and 96 per cent of these (8, 087) were examined by a team of school medical officers. A history of wheezing was obtained in 16 · 2 per cent; 1 · 8 percent had had wheezing alone, while the majority (14-4 per cent) gave a history of both wheezing and productive cough. Productive cough alone was reported in a further 32·5 per cent The parents reported that 17·1 per cent of seven-year-old children had more than two or three colds a year, 5-7 per cent had 'hay fever’, and 6-8 per cent had both. There was a close association between upper and lower respiratory symptoms, the prevalence of upper respiratory symptoms ranging from 15-5 per cent in those with no lower respiratory symptoms to 60·4 per cent in those with a history of both wheezing and productive cough. Despite considerable overlap, “colds” tended to be associated with productive cough and'hay fever'with wheezing. According to the questionnaire replies, lower respiratory symptoms were commoner (48 · 6 percent) than upper respiratory symptoms (29·6 percent). Episodes of productive cough were longer in duration, less frequent and started later in life than episodes of wheezing. Those with a history of both wheezing and productive cough resembled those with wheezing alone more closely than those with productive cough alone, but tended to be more severely affected than those with wheezing alone. Eczema and other indices of atopy were associated with a history of wheezing, and also, after elimination of the effect of wheezing, with hay fever. In this respect those with productive cough alone and those with colds alone did not differ significantly from those without symptoms. Physical signs, such as the presence of a ‘loose’ cough and abnormalities on auscultation, were more frequent in those with a history of wheezing than in those without and after elimination of the effect of wheezing, more frequent in those with hay fever than in those without Consideration of both questionnaire replies and clinical findings appears to confer significance on a classification of lower respiratory disease in children of this age based upon the answers to two questions, one on cough with sputum, or 'bronchitis', and the other on wheezing, or ‘asthma’.