Dry Night Cough Research Articles

Phenotypes of cough in children: A latent class analysis.

Distinguishing phenotypes among children with cough helps understand underlying causes. Using a statistical data-driven approach, we aimed to identify and validate cough phenotypes based on measurable traits, physician diagnoses, and prognosis. We used data from the Swiss Paediatric Airway Cohort and included 531 children aged 5-16 years seen in outpatient clinics since 2017. We included children with any parent-reported cough (i.e. cough without a cold, cough at night, cough more than other children, or cough longer than 4 weeks) without current wheeze. We applied latent class analysis to identify phenotypes using nine symptoms and characteristics and selected the best model using the Akaike information criterion. We assigned children to the most likely phenotype and compared the resulting groups for parental atopy history, comorbidities, spirometry, fractional exhaled nitric oxide (FeNO), skin prick tests and specific IgE, physician diagnoses, and 1-year prognosis. We identified four cough phenotypes: non-specific cough (26%); non-allergic infectious and night cough with snoring and otitis (4%); chronic allergic dry night cough with snoring (9%); and allergic non-infectious cough with rhino-conjunctivitis (61%). Children with the allergic phenotype often had family or personal history of atopy and asthma diagnosis. FeNO was highest for the allergic phenotype [median 17.9 parts per billion (ppb)] and lowest for the non-allergic infectious phenotype [median 7.0 parts per billion (ppb)]. Positive allergy test results differed across phenotypes (p < .001) and were most common among the allergic (70%) and least common among the non-specific cough (31%) phenotypes. Subsequent wheeze was more common among the allergic than the non-specific phenotype. We identified four clinically relevant cough phenotypes with different prognoses. Although we excluded children with current wheeze, most children with cough belonged to allergy-related phenotypes.

Phenotypic characteristics, healthcare use, and treatment in children with night cough compared with children with wheeze.

Population-based studies of children with dry night cough alone compared with those who also wheeze are few and inconclusive. We compared how children with dry night cough differ from those who wheeze. LuftiBus in the school is a population-based study of schoolchildren conducted between 2013 and 2016 in Zurich, Switzerland. We divided children into four mutually exclusive groups based on reported dry night cough (henceforth referred as "cough") and wheeze and compared parent-reported symptoms, comorbidities, exposures, FeNO, spirometry, and healthcare use and treatment. Among 3457 schoolchildren aged 6-17 years, 294 (9%) reported "cough," 181 (5%) reported "wheeze," 100 (3%) reported "wheeze and cough," and 2882 (83%) were "asymptomatic." Adjusting for confounders in a multinomial regression, children with "cough" reported more frequent colds, rhinitis, and snoring than "asymptomatic" children; children with "wheeze" or "wheeze and cough" more often reported hay fever, eczema, and parental histories of asthma. FeNO and spirometry were similar among "asymptomatic" and children with "cough," while children with "wheeze" or "wheeze and cough" had higher FeNO and evidence of bronchial obstruction. Children with "cough" used healthcare less often than those with "wheeze," and they attended mainly primary care. Twenty-two children (7% of those with "cough") reported a physician diagnosis of asthma and used inhalers. These had similar characteristics as children with wheeze. Our representative population-based study confirms that children with dry night cough without wheeze clearly differed from those with wheeze. This suggests asthma is unlikely, and they should be investigated for alternative aetiologies, particularly upper airway disease.

Prevalence of childhood cough in epidemiological studies depends on the question used: findings from two population-based studies

Epidemiological studies use different questions to assess recurrent cough in children. In two independent population-based studies, we assessed how prevalence estimates of cough vary depending on the questions parents are asked about their child's cough and how answers to the different questions overlap. We analysed cross-sectional data from two population-based studies on respiratory health:LuftiBus in the School(LUIS), conducted in 2013-2016 among 6- to 17-year-school children in the Canton of Zurich, Switzerland, and the 1998Leicester Respiratory Cohort(LRC) study, UK where we used data from 6- to 8-year-old children from the 2003 follow-up survey. Both studies used parental questionnaires that included the same three questions on the child's cough, namely cough without a cold, dry cough at night and coughing more than others. We assessed how the prevalence of cough varied depending on the question and how answers to the different questions on cough overlapped. We also assessed how results were influenced by age, sex, presence of wheeze and parental education. We included 3457 children aged 6-17 years from LUIS and 2100 children aged 6-8 years from LRC. All respiratory outcomes - cough, wheeze and physician-diagnosed asthma - were reported twice as often in the LRC as in LUIS. We found large differences in the prevalence of parent-reported cough between the three cough questions. In LUIS, 880 (25%) parents reported cough without a cold, 394 (11%) dry night cough, and 159 (5%) reported that their child coughed more than other children. In the LRC, these numbers were 1003 (48%), 527 (25%) and 227 (11%). There was only partial overlap of answers, with 89 (3%) answering yes to all questions in LUIS and 168 (8%) in LRC. Prevalence of all types of cough and overlap between the cough questions was higher in children with current wheeze. In both population-based studies prevalence estimates of cough depended strongly on the question used to assess cough with only partial overlap of responses to different questions. Epidemiological studies on cough can only be compared if they used exactly the same questions for cough.

Prevalence and Severity of Asthma, Rhinitis and Eczema in Pre-School Children in the United Arab Emirates

Very few studies have been carried out on asthma and allergies in pre-schoolchildren. This is the first study of pre-school children with asthma and allergies in the United Arab Emirates. We studied 4,000 pre-schoolchildren from the United Arab Emirates: Dubai, Sharjah, Abu Dhabi, and Al-Ain. The ages of the study group were between 1-5 years, and were 2,000 boys and 2,000 girls; they were randomly selected from kindergartens and nurseries. We used the standardised International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The mean (SD) age, height, weight and BMI were 3.3 (1.4) years, 92.0 (1.3) cm, 17.3 (5.2) kg, and 23.4 (9.3). The prevalence rates of “wheeze ever”, “current wheeze”, “speech limitation”, “asthma” , “dry night cough”, and “exercise-induced asthma” were 40.4%, 43.8%, 37.6%, 26.5%, 36.1, and 37.6%, respectively. Boys had a significantly higher prevalence of wheeze ever and current wheeze than girls. Girls had a significantly higher prevalence of speech limitation than boys. The prevalence rates of “rhinitis ever”, “current rhinitis”, “itchy watery eyes” and “hay fever” were 42%, 40.5%, 39.1% and 46.9%, respectively. Boys had significantly higher prevalence rates of “rhinitis ever”, “current rhinitis”, and “itchy watery eyes” than girls. The prevalence rates of “rash ever”, “current rash” and “eczema ever” were 38.9%, 33.7% and 58.0%, respectively. Boys had significantly higher prevalence rates of rash ever, current rash, and eczema ever than girls. Children who were exposed to parental smoking have significantly higher prevalence rates of asthma, wheezing, and cough than those whom were not exposed. Children who breastfed more than 10 months had a significantly lower prevalence rates of “wheeze ever”, “current wheeze”, “speech limitation”, and “asthma”, than those whom breastfed less than 10 months. The prevalence rates of asthma, rhinitis and eczema were very high. Breastfeeding was found to be protective for asthma. The study can be used as a baseline intervention project to reduce incidents of asthma and allergies in these children and to establish atopic march in order to implement strategies to improve the respiratory health and allergies in these children. Keywords: asthma, wheeze, night cough, rhinitis, eczema, pre-school children, paediatric asthma

Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study

BackgroundThe Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers. MethodsAdolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire. ResultsAlthough the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms. ConclusionsAdolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.

Effects of parental smoking and indoor tobacco smoke exposure on respiratory outcomes in children

The extensive literature has reported adverse effects on environmental tobacco smoke (ETS) on children’s health. We aim to analyze associations of ETS with dry night cough, croup, pneumonia, and frequent common cold and to disentangle the effects of prenatal, infancy and childhood exposure by multilevel logistic regression. A cross-sectional study was conducted among 41,176 children aged 3–8 years in 8 major cities of China during 2010–2011, and obtained demographic information, smoke exposure information, and respiratory outcomes. Parents’ smoking habit and indoor tobacco smoke odor were considered as two indicators of ETS. The prevalences of respiratory outcomes were 6.0% for croup, 9.5% for frequency common cold, 17.1% for dry night cough and 32.3% for pneumonia respectively in the study. The associations between respiratory outcomes and parental smoking were not obvious, while indoor tobacco smoke odor was clearly and strongly associated with most respiratory outcomes, with adjusted odds ratios ranging from 1.06 to 1.95. Both infancy and childhood exposure to tobacco smoke odor were independent risk factors, but infancy exposure had a higher risk. The results explore that ETS increased the risk of respiratory outcomes in children, highlighting the need for raising awareness about the detrimental effects of tobacco smoke exposure.

Associations of residential exposure to agricultural pesticides with asthma prevalence in adolescence: The PIAMA birth cohort

BackgroundIt has been suggested that children who are exposed to agricultural pesticides have an increased risk of asthma, but evidence for associations betweeen residential pesticide exposure and childhood asthma is inconsistent. ObjectivesTo investigate the associations of residential pesticide exposure with the prevalence of asthma and related symptoms within a Dutch birth cohort study. MethodsIn this cross-sectional analysis, we included participants of the PIAMA birth cohort study with data on residential pesticide exposure and asthma from parent-completed questionnaires at age 14, collected in 2012 (N = 1473). We used spatial data on the presence of individual crops (cereals, open field vegetables, commercial crops, open field floriculture/bulbs, corn and potatoes) and pesticide application on these crops to estimate residential exposure to pesticides with known irritant properties for the respiratory system within distances of 100, 500, and 1000 m of the participants' homes. Logistic regression was used to estimate associations between exposure and outcomes, adjusting for potential confounders. ResultsNo associations were found between living within 100, 500 and 1000 m of agricultural fields likely treated with pesticides and symptoms of asthma. For instance, for participants living within 100 m of fields with any crops likely treated with pesticides, the adjusted odds ratios (95% confidence interval) for the prevalence of asthma, shortness of breath and dry night cough at age 14 were 0.31 (0.07, 1.32), 0.61 (0.23, 1.57) and 1.26 (0.56, 2.80), respectively. No associations were found between estimated exposure to pesticides with known irritant properties for the respiratory system and asthma or related symptoms. ConclusionsThere was no association between living near agricultural fields likely treated with pesticides and asthma and related respiratory symptoms, among our study participants.

Early Exposure to Traffic-Related Air Pollution, Respiratory Symptoms at 4 Years of Age, and Potential Effect Modification by Parental Allergy, Stressful Family Events, and Sex: A Prospective Follow-up Study of the PARIS Birth Cohort.

Background:The relation between traffic-related air pollution (TRAP) exposure and the incidence of asthma/allergy in preschool children has been widely studied, but results remain heterogeneous, possibly due to differences in methodology and susceptibility to TRAP.Objectives:We aimed to study the relation of early TRAP exposure with the development of respiratory/allergic symptoms and asthma during preschool years, and to investigate parental allergy, “stressful” family events, and sex as possible effect modifiers.Methods:We examined data of 2,015 children from the PARIS birth cohort followed up with repeated questionnaires completed by parents until age 4 years. TRAP exposure in each child’s first year of life was estimated by nitrogen oxides (NOx) air dispersion modeling, taking into account both home and day care locations. Association between TRAP exposure and patterns of wheezing, dry night cough, and rhinitis symptoms was studied using multinomial logistic regression models adjusted for potential confounders. Effect modification by parental history of allergy, stressful family events, and sex was investigated.Results:An interquartile range (26 μg/m3) increase in NOx levels was associated with an increased odds ratio (OR) of persistent wheezing at 4 years (adjusted OR = 1.27; 95% confidence interval: 1.09, 1.47). TRAP exposure was positively associated with persistent wheeze, dry cough, and rhinitis symptoms among children with a parental allergy, those experiencing stressful family events, and boys, but not in children whose parents did not have allergies or experience stressful events, or in girls (all interaction p-values < 0.2).Conclusions:This study supports the hypothesis that not all preschool children are equal regarding TRAP health effects. Parental history of allergy, stressful family events, and male sex may increase their susceptibility to adverse respiratory effects of early TRAP exposure.Citation:Rancière F, Bougas N, Viola M, Momas I. 2017. Early exposure to traffic-related air pollution, respiratory symptoms at 4 years of age, and potential effect modification by parental allergy, stressful family events, and sex: a prospective follow-up study of the PARIS birth cohort. Environ Health Perspect 125:737–745; http://dx.doi.org/10.1289/EHP239

Onset and Persistence of Respiratory/Allergic Symptoms in Preschoolers: New Insights From the PARIS Birth Cohort.

F Ranciere, L Nikasinovic, J Bousquet, I Momas. Allergy. 2013;68(9):1158–1167 The goal of this study was to identify wheezing and asthma phenotypes based on the time course of respiratory/allergic symptoms throughout preschool years. A total of 3840 term healthy infants born between 2003 and 2006 were enrolled in a population-based birth cohort study (PARIS). Of the 3840 children initially enrolled in the cohort, 2522 children were included in the cluster analysis. Data (including symptoms of wheezing, dry night cough, rhinitis, and dermatitis) were collected annually from birth to 4 years of age. K-means clustering was used to group, into phenotypes, children with …

Curative effect observation on self-designed Maxing-Chansu decoction in treating children cough or night cough

Objective To observe the clinical efficacy and adverse reactions of self designed Maxing-Chansu decoction in the treatment of infantile cough and night cough. Methods 100 dry cough and night cough patients were randomly divided into two groups, with 60 patients in a treatment group, 40 patients in a control group. The control group was treated with conventional treatment including anti infection, inhalation, and symptomatic treatment（with promethazine oral liquid as the positive control）. The treatment group was treated with Chinese medicine Maxing-Chansu decoction on the basis of the control group. The course of disease, cough and adverse reactions were observed in both groups. Results The total effective rate was 100%and 85%in the treatment group and the control group respectively, with statistical difference（χ2=15.2,P〈0.05）. The time of children’s anhelation remission, cough disappearance, lung rale disappearance in the treatment group was（2.5± 0.6）d,（4.1±0.8）d, and（4.2±0.7）d respectively, which were shorter than those（5.8±0.5）d,（8.8±0.9）d, （6.7±0.8）d, and P〈0.05 in the control group. The average hospitalization date of treating children with bronchitis, bronchopneumonia, and cough variant asthma was（4.3±0.4）d,（7.8±0.5）d, and（6.5±0.5）d, which were shorter than those（7.3±0.5）d,（10.8±0.7）d,（9.5±0.6）d in the control group, P〈0.05. Conclusion The traditional Chinese medicine Maxing-Chansu decoction in treating children cough and night cough was quick, reliable and with stable curative effect, which was worth further study and promotion. Key words: Pediatric cough and night cough; Chinese medicine treatment; Clinical effect

Onset and persistence of respiratory/allergic symptoms in preschoolers: new insights from the PARIS birth cohort

The natural course of childhood asthma and allergy is complex and not fully understood. We aimed to identify phenotypes based upon the time course of respiratory/allergic symptoms throughout preschool years. As part of the PARIS cohort, symptoms of wheezing, dry night cough, rhinitis and dermatitis were collected annually from birth to age 4 years. K-means clustering was used to group into phenotypes children with similar symptoms trajectories over the study period. Associations of phenotypes with IgE sensitization and risk factors were studied using multinomial logistic regression. Besides a group with low prevalence of symptoms considered as reference (n = 1236, 49.0%), four distinct respiratory/allergic phenotypes were identified: two transient [transient rhinitis phenotype (n = 295, 11.7%), transient wheeze phenotype (n = 399, 15.8%)], without any relation with IgE sensitization, and two persistent [cough/rhinitis phenotype (n = 284, 11.3%), dermatitis phenotype (n = 308, 12.2%)], associated with IgE sensitization. Transient rhinitis phenotype was only associated with tobacco smoke exposure, which could irritate the airways. Transient wheeze phenotype was related to male sex and contact with other children (older siblings, day care attendance). Lastly, risk factors for both IgE-associated phenotypes encompassed parental history of allergy, potential exposure to allergens and stress, known to be associated with the development of allergic diseases. This study provides evidence for the existence of different respiratory/allergic phenotypes before school age. The fact that they differ in terms of sensitization and risk factors reinforces the plausibility of distinct phenotypes, potentially linked to irritation and infections for the transient phenotypes and to allergy for the persistent phenotypes.

Dry night cough as a marker of allergy in preschool children: the PARIS birth cohort

Early detection of children at risk for developing allergy is an important challenge. Our first analyses in infants from the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort suggested that dry night cough was associated with parental-reported allergic disorders. The aim of the present study was to refine this finding by investigating the time course of dry night cough from birth to age 4yr in relation to blood markers of atopy and allergic morbidity. Health outcomes were regularly assessed by parental self-administered questionnaires. Blood markers of atopy were measured at age 18months. Children with similar patterns of dry night cough over the first 4yr of life were grouped together using k-means clustering. Associations with atopy/allergy were studied using multinomial logistic regression. Three trajectories of dry night cough were identified in 1869 children. Besides the never/infrequent pattern (72.4%), the transient pattern (8.8%) was composed of children who coughed in the first year and recovered by age 4yr, while the rising pattern (18.8%) included all symptomatic children at age 4yr, whether they were persistent or late coughers. Compared with the never/infrequent pattern, the rising pattern was significantly associated with elevated total immunoglobulin E (IgE) level (odds ratio [OR]=1.70, 95% confidence interval [CI]=1.21-2.39) and inhalant allergens sensitization (OR=2.66, 95% CI=1.26-5.61) at age 18months, and with doctor-diagnosed allergic diseases over the first 4yr such as hay fever (OR=2.52, 95% CI=1.49-4.26) and eczema (OR=1.29, 95% CI=1.00-1.66). This study provides evidence that persistent/late dry night cough may indicate allergy in preschool children.

The self-reported density of truck traffic on residential streets and the impact on asthma, hay fever and eczema in young adolescents

BackgroundConflicting results have been reported, mostly in developed countries, on the relationship between exposure to traffic and allergic diseases. This study aims to examine the impact of truck traffic on asthma, rhinitis and eczema in early adolescence in Skopje, the capital of the Republic of Macedonia, as a developing country with a lower middle rate of high truck traffic exposure and low prevalence rates of allergic diseases. MethodsSelf-reported data was used, obtained through the International Study of Asthma and Allergies in Childhood Phase 3 written questionnaires, from 3026 adolescents aged 13–14 years from Skopje. Truck traffic density on the street of residence on weekdays was correlated to current and ever-diagnosed asthma, rhinitis and eczema by odds ratios (OR, 95% CI) in binary logistic regression, with and without adjustments for potential confounding factors separately and for their joint effect. ResultsA positive association of truck traffic density appeared to be limited to current dry night cough (aOR: 1.63; 1.07–2.47; aOR: 2.17; 1.40–3.35; and aOR: 2.33; 1.43–3.79 for truck traffic seldom, frequently through the day, and almost the whole day, respectively) with an exposure–response relationship and to current wheeze only for truck traffic almost the whole day (aOR: 1.87; 1.02–3.42). ConclusionThe findings suggest an aggravating effect of truck traffic on current asthma symptoms, but not on asthma, allergic rhinitis and eczema diagnoses. It seems that it probably has an impact as a direct respiratory irritant in early adolescence.

Cough and dyspnoea may discriminate allergic and infectious respiratory phenotypes in infancy

Asthma symptoms are non-specific during infancy, making the identification of different subgroups among preschool children with early respiratory manifestations an important challenge. We previously used a clustering approach to identify bronchial obstructive phenotypes in 1-yr-old infants from the Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort. In the present study, we examined whether these phenotypes were stable at 3 yr and studied their comorbidity and risk factors. Partitioning around medoids (PAM) method was applied at 1 and 3 yr of age to cluster children according to wheezing, dry night cough, dyspnoea with sleep disturbance and breathlessness. The resulting groups were used to derive phenotypes in 2084 children during their first 3 yr of life. Analysis of associated comorbidity and risk factors was conducted using multinomial logistic regression. PAM groups were similarly defined at both ages so that two respiratory phenotypes were identified between birth and 3 yr: cough phenotype (CP) and dyspnoea phenotype (DP) including 14.1% and 30.7% of children, respectively. CP infants experienced more often allergic features than DP, dominated by respiratory infections. Parental history of allergy, potential allergen exposure and psychosocial factors were associated with CP. Day care centre attendance was more frequent in DP as well as exposure to domestic chemical pollution, suggesting a greater vulnerability to pathogens. Finally, dry night cough and dyspnoea disturbing the sleep appear to be markers of two respiratory profiles potentially allergic and infectious before 3 yr old.

Traffic‐related air pollution and dry night cough during the first 8 years of life

Traffic‐related air pollution and dry night cough during the first 8 years of life

Exposure to traffic exhaust and night cough during early childhood: the CCAAPS birth cohort

Though studies have investigated the association between air pollution and respiratory health outcomes in children, few have focused on night cough. The study objective was to simultaneously evaluate family factors (i.e., race, gender, maternal and paternal asthma, and breastfeeding), health (allergen sensitization and wheezing symptoms), home factors (dog, cat, mold, endotoxin, and dust mite), and other environmental exposures (traffic exhaust and second-hand tobacco smoke) for associations with recurrent dry night cough (RNC) during early childhood. A structural equation model with repeat measures was developed assessing RNC at ages one, two, and three. The prevalence of RNC was relatively large and similar at ages, one, two, and three at 21.6%, 17.3%, and 21.1%, respectively. Children exposed to the highest tertile of traffic exhaust had an estimated 45% increase in risk of RNC compared with children less exposed (adjusted OR 1.45, 95% CI: 1.09, 1.94). Also, wheezing was associated with a 76% higher risk of RNC (adjusted OR 1.76, 95% CI: 1.36, 2.26). A protective trend for breastfeeding was found with a 27% reduction in risk associated with breastfeeding (adjusted OR 0.73, 95% CI: 0.53, 1.01). No other factors were significant. These results suggest that traffic exhaust exposure may be a risk factor for night cough in young children.

Overweight hypothesis in asthma and eczema in young adolescents

Background A positive association between body mass index (BMI) and allergic diseases has recently been suggested; however the sex-dependence of this association remains controversial. The aim of the present study was to explore the relationship between BMI and asthma and eczema, as well as its sex-dependence in young adolescents. Methods Self-reported data obtained through the standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three written questionnaires of 2926 young adolescents aged 13-14 years old from randomly selected schools in Skopje (Republic of Macedonia) were used. The BMI for each individual was calculated and used-both unadjusted and adjusted for confounding factors-as a variable for analysis. The international cut-off points for BMI for overweight and obesity by sex and age were used. Because of the very low prevalence of obesity (1.5 %), obese respondents were included in the overweight group. The data were statistically analyzed by the chi-square test, the t-test for independent samples and odds ratios (OR, 95 % CI) in binary logistic regression. Results Being overweight was significantly associated with an increased risk of having a dry night cough without a cold or chest infection (adjusted OR: 1.54; 95 % CI: 1.09-2.16; p = 0.01) and with having had self-reported asthma at some time (adjusted OR: 2.36; 95% CI: 1.02-5.44; p = 0.04) in boys only. A significant association between overweight and other symptoms of asthma or atopic eczema was not established. Conclusion These findings suggest a male-specific positive association between overweight and a current dry night cough and having received a diagnosis of asthma at some time. No association was found with other asthma symptoms or atopic eczema in young adolescents.