Nocturnal Dry Cough Research Articles

A tale of noisy airways: Asthma or not?

A young female in her early twenties presented with complaints of sneezing, nocturnal dry cough, chest tightness and occasional nocturnal wheeze. She reported occasional reflux symptoms. She denied loss of weight, loss of appetite or fever.

Fruit flavors in electronic cigarettes (ECIGs) are associated with nocturnal dry cough: A population longitudinal analysis.

Evidence from in vitro and animal models has identified the pulmonary toxicity of flavors in electronic cigarettes (ECIGs); however, less is known from epidemiological studies about the effects of flavors in the respiratory health. This study examined the longitudinal association between exposure to ECIGs flavors and nocturnal dry cough among ECIGs users. A secondary analysis of data from the Population Assessment of Tobacco and Health Study (2014-2019) was conducted. The study population included adults who provided information (n = 18,925) for a total of 38,638 observations. Weighted-incidence estimates and weighted- generalized estimating equation models were performed to assess unadjusted and adjusted associations. The weighted incidence proportion (WIP) of nocturnal dry cough was significantly higher among current (WIP:16.6%; 95%CI 10.5, 21.2) and former fruit flavored ECIGs users (WIP:16.6%; 95%CI 11.3, 21.9) as compared to non-ECIGs users (WIP:11.1%; 95%CI 10.6, 11.6). Current ECIGs users of fruit flavors showed 40% higher risk of reporting cough than non-ECIGs users (aRR:1.40, 95%CI 1.01, 1.94). Former ECIGs users of multiple flavors and other flavors had 300% and 66% higher risk to develop cough, respectively (aRR:3.33, 95%CI 1.51, 7.34 and aRR:1.66, 95%CI 1.0.9, 2.51), relative to non-ECIGs users. We observed a significantly higher risk of developing nocturnal dry cough in the past 12 months in current and former ECIGs users of fruit flavors and in former ECIGs users of multiple flavors. To the extent that cough may serve as an early indicator of respiratory inflammation and potential disease risk, the association between ECIGs use and cough raises potential concerns.

Tracheobronchopathia Osteochondroplastica: Two Different Facets of a Rare Entity.

Tracheobronchopathia osteochondroplastica (TBPO) can present as a diffuse large airway disease with mild obstructive symptoms or as severe tracheal obstruction.Direct observation by bronchial fibroscopy of lumen protrusions sparing the posterior wall is diagnostic.

Prevalence of bronchial asthma and its associated risk factors in school-going adolescents in Tier-III North Indian City.

Background:Asthma is one of the most common chronic diseases of childhood and a major health problem not only in India but globally. Despite multifold increase in prevalence, there is paucity of data on bronchial asthma from non-metro cities. The objectives were to find prevalence of bronchial asthma and various risk factors that are associated in this age group and determine the extent of under diagnosis.Materials and Methods:A cross-sectional study involving 927 students from four government and three private schools was conducted using International Study of Asthma and Allergies in Childhood questionnaire.Results:Prevalence of bronchial asthma in adolescents was 13.1% (n = 121) of which 10.3% had episodes in the past 1 year. Prevalence was higher among males (8.77%) compared to females (4.33%). About 77.7% of total asthmatics were newly diagnosed cases. Prevalence was significantly higher among those having pets at home (P < 0.001), belonging to higher socioeconomic status (P = 0.021), using smoke-producing fuel at home (firewood/cow dung/kerosene; P = 0.032), and with history of smoking among family members (P = 0.035). Among current asthmatics, 72.3% reported cold/rhinitis (54.6% in March–May duration), 63.6% nocturnal dry cough, 50.5% sleep disturbances, and 38.9% speech disturbances in the past 1 year.Conclusion:The study shows higher prevalence of bronchial asthma in school-going population (11–16 years) compared to other parts of Northern India possibly attributable to rapid industrialization and post harvesting season when the study was carried out. Preventive interventions need to be taken to reduce disease burden at community level.

Dampness and microbial secondary metabolites in schools and respiratory symptoms in children: the HITEA study

Introduction: Dampness and mould exposure have been linked to respiratory symptoms, but studies on causative agents are limited. We aim to explore whether microbial secondary metabolites explain associations between moisture and mould in schools and the presence of respiratory symptoms in pupils. Methods: Primary schools in Spain, the Netherlands and Finland were selected based on presence (n=29) or absence (n=26) of reported and observed dampness and/or mould. Ten dust samples per school were collected and targeted for 188 secondary metabolites using liquid chromatography/mass spectrometry. In total 30 different metabolites were found. Information was obtained from 9068 children (response 62%) on respiratory symptoms and potential determinants using parent-administered questionnaires. Associations between metabolites and respiratory symptoms were analyzed by mixed logistic regression. Results: In Finland pupils attending damp schools reported more often respiratory symptoms in the past 12 months, like current wheeze (Odds Ratio(OR) 1.6; 95%CI (1.1-1.8)), phlegm (OR 1.3; 0.9-1.8), nocturnal dry cough (OR 1.3; 1.0-1.8) and nasal symptoms (OR 1.3; 1.0-1.7). Mutual adjustment for average number of metabolites per school did not affect associations, while associations between metabolite load and symptoms changed slightly when adjusting for school dampness. In Finland higher metabolite loads tended to be associated with an increased symptom prevalence. Associations were not different for metabolites of a predominantly indoor or outdoor context. While the overall average number of detectable metabolites did not affect respiratory symptoms, in the Netherlands symptoms were associated with average numbers of ‘indoor’ metabolites and in Finland with ‘outdoor’ metabolites. Conclusions: Secondary metabolites do not seem to explain the moisture damage effect in schools in our study. Also the evidence for their effect on respiratory symptoms in pupils was weak.

Phenytoin-induced isolated chronic, nocturnal dry cough.

We report a 72-year-old man with a four-year history of dyscognitive seizures (with occasional secondary generalization) who developed isolated, nocturnal dry cough immediately after being started on PO phenytoin. The cough was not accompanied by any other symptom or sign as his physical exam was completely normal. Further investigation with chest CT and spirometry was unremarkable. This symptom persisted for six months and did not resolve until we weaned him off of phenytoin. According to the Naranjo Adverse Drug Reaction Probability Scale, his cough was classified as being probably (score + 6) related to the use of this antiepileptic drug. To our knowledge, there has been only one study that reported phenytoin-triggered cough. It described a postoperative patient who developed cough and bronchospasm after receiving IV phenytoin. By reporting our case and discussing the literature on this specific topic, we have essentially two goals. First, we intend to remind clinicians that isolated persistent cough can be an adverse reaction to phenytoin. Second, we hope to encourage further studies that will be able to elucidate the association presented herein.

Nocturnal dry cough in the first 7 years of life is associated with asthma at school age.

Childhood wheeze is an important, well-known risk factor for asthma, yet little is known about the contribution of nocturnal dry cough. We investigated the association of nocturnal dry cough at ages 1-7 years with doctor-diagnosed asthma at 8 years of age, both in the presence and absence of wheeze. Data of 3,252 children from the PIAMA birth cohort were studied. Parents reported the presence of nocturnal dry cough, wheeze, and doctor-diagnosed asthma in the past 12 months yearly, from birth up to the age of 8 years. Nocturnal dry cough without wheeze was significantly associated with doctor-diagnosed asthma at age 8, except for age 1 (range of Relative Risks (RR) at ages 2-7: 1.8 (age 5) - 7.1 (age 7), all P-values <0.048). As expected, wheeze without nocturnal dry cough was strongly associated with doctor-diagnosed asthma at age 8 (range of RR: 2.0 (age 1) - 22.2 (age 7), all P-values <0.003). Of interest, nocturnal dry cough with wheeze showed the strongest association with doctor-diagnosed asthma at age 8 (range of RR: 3.7 (age 1) - 26.0 (age 7), all P-values <0.001). The relative excess risk of asthma at age 8 due to interaction of nocturnal dry cough with wheeze at age 1 year was 1.8 (0.1-3.6, P < 0.01). Nocturnal dry cough and wheeze in early childhood are both independently associated with asthma at school age. The presence of both nocturnal dry cough and wheeze at age 1 almost doubles the risk of asthma at age 8 compared to wheeze alone.

Prevalence of bronchial asthma and its associated factors among school children in urban Puducherry, India

Background:Bronchial asthma is an important public health problem at the global level. There is paucity of studies on bronchial asthma among school children in Urban India.Objective:To assess the prevalence and associated factors of bronchial asthma among school children.Materials and Methods:A cross-sectional study was conducted among 263 children studying in the 8th, 9th, and 10th standard using the modified International Study on Allergy and Asthma in Childhood questionnaire in Urban Puducherry. Data on associated factors that include family history of asthma, type of fuel used for cooking, placement of kitchen in the house, number of windows in sleeping room, pet animals, smoking among family members, birth order, and smoke outlet were collected. Data were analyzed by univariate analysis and expressed in proportion or percentages.Results:Prevalence of ever bronchial asthma was found to be 5.3%, of which 4.2% had current episode of asthma during the last 1-year period. About 72.7% of the current asthmatics had cold or rhinitis and 54.5% each had itching or rashes and nocturnal dry cough. Prevalence is more among the 12-13 years age group (6.5%) compared to the 14-16 years age group (3.6%). Boys (5.4%) and girls (5.2%) had comparable prevalence rates. The prevalence was significantly more among those with a family history of asthma, having smoking habits in any of the family members, and the absence of smoke outlet in the house (P < 0.05).Conclusion:Bronchial asthma is an important health problem among children in urban Puducherry. Intervention on exposure to passive smoking and provision of smoke outlets may help to reduce the burden of disease at the community level.

Dampness and mould in schools and respiratory symptoms in children: the HITEA study

BackgroundThe adverse respiratory health effects of dampness and mould in the home have been extensively reported, but few studies have evaluated the health effects of such exposures in schools.ObjectivesTo assess...

Environmental triggers of nocturnal dry cough in infancy: New insights about chronic domestic exposure to formaldehyde in the PARIS birth cohort

Although formaldehyde is a common indoor pollutant, its impact on respiratory symptoms in childhood remains unclear.The aim of this study was to examine the relation between domestic formaldehyde exposure and occurrence of coughing, one of the most prevalent respiratory symptoms during the first year of life of infants from the PARIS birth cohort involving 3840 healthy full-term babies. The presence of respiratory symptoms, including dry cough at night apart from a cold or chest infection in the past 12 months was reported on a standardized health questionnaire. Formaldehyde exposure was estimated for all infants using a predictive model established from data (both repeated measurements and information about determinants of levels) collected in a random sample of infants from the cohort. An unconditional logistic regression was fitted to study the relation between annual domestic formaldehyde exposure and dry cough at night, adjusting for all potential risk factors/confounders.The prevalence of dry cough at night was 14.9%. Parental history of allergy was found to modify the relation between environmental factors and dry cough. Cockroaches, used mattresses, and family stressor events were associated with dry cough in infants with parental allergy history. Conversely, domestic formaldehyde exposure tended to increase occurrence of dry cough at night only among babies without parental history of allergy (adjusted OR per 10µg/m3 increase in levels, single imputation approach: 1.45, 95% CI: 1.08–1.96, and Bayesian approach: 1.12, 0.91–1.36).This study suggests that the impact of indoor environmental exposure on dry cough at night in infancy is different depending on the presence or not of parental history of allergy.

Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit

The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation <95%) associated with no use of topical airway lidocaine (TAL), with TAL sprayed directly onto the vocal cords, and TAL administered blindly into the pharynx was assessed. This prospective audit involved 1000 patients undergoing general anesthesia with elective endotracheal intubation without NMB. Patients with suspected difficult airways or undergoing airway surgery were excluded. The use of TAL and the mode of administration were recorded. Respiratory adverse events were recorded in the perioperative period. Two hundred and fifty-four patients had the vocal cords sprayed under direct vision, 236 had lidocaine blindly dripped into the pharynx, and 510 received no TAL. The mean age and known risk factors for PRAE (asthma, recent upper respiratory tract infection (≤2 weeks), passive smoking, hayfever, past or present eczema, nocturnal dry cough) were similar among the groups. The proportion of patients with desaturation (<95%) between induction of anesthesia and discharge from the recovery room was higher in the two groups who received TAL (data combined for all patients receiving lidocaine regardless of administration method, P = 0.01) compared to those who received no TAL. No difference in the rates of laryngospasm (P = 0.13) or cough (P = 0.07) was observed among the groups. There was no difference in the rates of PRAE between the groups given TAL directly onto the vocal cords and in those whom received TAL blindly. The incidence of desaturation was higher in patients receiving TAL compared with children who did not. This association should perhaps be considered when contemplating the use of this technique.

A 77-Year-Old Woman With Dyspnea and Raynaud Phenomenon

A 77-year-old black woman who was a lifelong nonsmoker presented to our office for evaluation of worsening dyspnea over the last year that had severely limited her activities of daily living. Her medical history included type 2 diabetes, hypertension, and pacemaker placement. She reported paroxysmal nocturnal dyspnea and dry cough. She denied fevers, chills, chest pain, hemoptysis, or weight loss. She also reported whitening of her fingers with cold temperatures, suggestive of Raynaud phenomenon (RP). However, this symptom was not apparent on the initial visit, and she did not complain of it at that time.

Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study

Perioperative respiratory adverse events in children are one of the major causes of morbidity and mortality during paediatric anaesthesia. We aimed to identify associations between family history, anaesthesia management, and occurrence of perioperative respiratory adverse events. We prospectively included all children who had general anaesthesia for surgical or medical interventions, elective or urgent procedures at Princess Margaret Hospital for Children, Perth, Australia, from Feb 1, 2007, to Jan 31, 2008. On the day of surgery, anaesthetists in charge of paediatric patients completed an adapted version of the International Study Group for Asthma and Allergies in Childhood questionnaire. We collected data on family medical history of asthma, atopy, allergy, upper respiratory tract infection, and passive smoking. Anaesthesia management and all perioperative respiratory adverse events were recorded. 9297 questionnaires were available for analysis. A positive respiratory history (nocturnal dry cough, wheezing during exercise, wheezing more than three times in the past 12 months, or a history of present or past eczema) was associated with an increased risk for bronchospasm (relative risk [RR] 8.46, 95% CI 6.18-11.59; p<0.0001), laryngospasm (4.13, 3.37-5.08; p<0.0001), and perioperative cough, desaturation, or airway obstruction (3.05, 2.76-3.37; p<0.0001). Upper respiratory tract infection was associated with an increased risk for perioperative respiratory adverse events only when symptoms were present (RR 2.05, 95% CI 1.82-2.31; p<0.0001) or less than 2 weeks before the procedure (2.34, 2.07-2.66; p<0.0001), whereas symptoms of upper respiratory tract infection 2-4 weeks before the procedure significantly lowered the incidence of perioperative respiratory adverse events (0.66, 0.53-0.81; p<0.0001). A history of at least two family members having asthma, atopy, or smoking increased the risk for perioperative respiratory adverse events (all p<0.0001). Risk was lower with intravenous induction compared with inhalational induction (all p<0.0001), inhalational compared with intravenous maintenance of anaesthesia (all p<0.0001), airway management by a specialist paediatric anaesthetist compared with a registrar (all p<0.0001), and use of face mask compared with tracheal intubation (all p<0.0001). Children at high risk for perioperative respiratory adverse events could be systematically identified at the preanaesthetic assessment and thus can benefit from a specifically targeted anaesthesia management. Department of Anaesthesia, Princess Margaret Hospital for Children, Swiss Foundation for Grants in Biology and Medicine, and the Voluntary Academic Society Basel.

Frecuencia de consumo de pescado de mar y síntomas de enfermedades alérgicas en adultos de Rosario

Background Sea fish (SF) is a natural source of omega-3 fatty acids (O3FA). Intake of O3FA reduces the production of arachidonic acid derivatives, which have antiinflammatory activity, and elevates levels of eicosapentaenoic acid derivatives, with lower activity. O3FA also inhibit T helper-2 lymphocytes, which mediate allergic inflammatory reactions. SF is a major food allergen and could also act as a histamine-releasing food. The objective of this study was to analyze the association between SF consumption and the presence of allergic symptoms. Methods We conducted a cross-sectional study in 765 randomly selected students (83.4% women), aged 17–65 years old, attending the Universidad del Centro Educativo Latinoamericano. The students completed validated questionnaires on allergic diseases and the frequency of SF intake. Results The prevalence of asthma symptoms in the previous 12 months was 8.0% among participants reporting SF consumption daily, weekly or once a month or more (46.7%) and was 12.9% in those reporting SF consumption less than once a month or never (p<0.05). Similar results were obtained when we evaluated exercise-induced asthma (7.9% vs 12.2%; p<0.05), nocturnal dry cough not associated with infections (13.3% vs 19.6%; p<0.05), allergic rhinoconjunctivitis in the last year (20.8% vs 27.5%; p<0.05) and symptoms of both allergic respiratory diseases (4.2% vs 8.7%; p<0.005). Statistical significance was maintained when stratification by sex, age, obesity, reflux and smoking habits was performed. In contrast, a higher frequency of urticaria symptoms was found in participants who reported SF consumption more than twice a week (29.5% vs 12.5%; p<0.05). Conclusions These data suggest that SF consumption at least once a month could protect against diseases such as asthma and allergic rhinoconjunctivitis, due to the O3FA content of SF. However, high SF intake could increase the prevalence of urticaria, probably because of allergic or pseudoallergic phenomena.

Air Pollution and Recent Symptoms of Asthma, Allergic Rhinitis, and Atopic Eczema in Schoolchildren Aged Between 6 and 7 Years

Objective The objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years. Patients and Methods The prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruña, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbon monoxide (CO), and total suspended particulate matter. Results The annual average concentration of SO 2 showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01–1.73), rhinitis (aOR, 1.56; 95% CI, 1.39–1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45–2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34-2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31–2.37), and eczema (aOR, 1.55; 95% CI, 1.17–2.04). The annual average concentration for NO 2 and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough. Conclusions Findings suggest that air pollutants such as SO 2 and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.

Contaminación del aire y síntomas recientes de asma, rinitis alérgica y eccema atópico en escolares de 6 y 7 años

Objective The objective of the study was to analyze the relationship between air pollutants and the prevalence of recent symptoms of asthma, allergic rhinitis, and atopic eczema in schoolchildren aged between 6 and 7 years. Patients and Methods The prevalence of recent (previous 12 months) symptoms of allergic diseases was obtained by means of the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC), Spain, with the participation of 7 centers (Asturias, Barcelona, Bilbao, Cartagena, La Coruña, Madrid, and Valencia) and 20 455 schoolchildren aged between 6 and 7 years, from 2002 to 2003. The pollutant detection systems of the aforementioned centers provided the mean annual concentrations of sulfur dioxide (SO 2), nitrogen dioxide (NO 2), carbon monoxide (CO), and total suspended particulate matter. Results The annual average concentration of SO 2 showed a significant association with a higher prevalence of recent severe asthma (adjusted odds ratio [aOR] between level-1 and level-3 pollution, 1.32; 95% confidence interval [CI], 1.01–1.73), rhinitis (aOR, 1.56; 95% CI, 1.39–1.75), and rhinoconjunctivitis (aOR, 1.70; 95% CI, 1.45–2.00). The annual average concentration of CO was associated with a higher prevalence of rhinitis (aOR, 1.65; 95% CI, 1.34–2.04), rhinoconjunctivitis (aOR, 1.76; 95% CI, 1.31–2.37), and eczema (aOR, 1.55; 95% CI, 1.17–2.04). The annual average concentration for NO 2 and total suspended particulate matter showed inverse associations with the prevalence of nocturnal dry cough. Conclusions Findings suggest that air pollutants such as SO 2 and CO increase the risk of recent symptoms of asthma and allergic rhinitis in schoolchildren aged between 6 and 7 years in Spain.

Bronchial obstructive phenotypes in the first year of life among Paris birth cohort infants

As the natural history of respiratory and allergic manifestations is unclear, our ongoing Paris birth cohort study prospectively assesses the onset of these symptoms in early childhood. Data were collected by five questionnaires sent at regular intervals during the first year of life. Partitioning around medoids (PAM) was used to classify infants according to their bronchial obstructive symptoms. A polytomous logistic regression was performed to assess the eventual predictable power of various respiratory events and perinatal factors. Results are given for 2698 infants. Atopic dermatitis occurred in 17.9% of infants. The main respiratory symptoms in infancy were wheeze in the chest (22%), dyspnoea responsible for sleep disturbance (23.7%), nocturnal dry cough (14.5%) and shortness of breath (4.2%). The PAM method identified three groups of infants. Apart from the G0 group of infants mostly asymptomatic, two distinct clinical phenotypes (G1 and G2: 8.7% and 23.5% of total infants respectively) emerged. G2 was defined by severe bronchial obstructive disorders as all cases of dyspnoea with sleep disturbance were included in this group, while all infants assigned in G1 suffered from nocturnal dry cough. G2 group infants had significantly higher rates of respiratory events while a parental history of asthma, symptoms suggestive of rhino-conjunctivitis and birth season clearly differentiated the G1 group. Finally, G1 and G2 group infants should be closely followed up as they are expected to develop allergic and asthmatic phenotypes, possibly in relation to environmental and behavioural risk factors.

Prevalência de asma em escolares e adolescentes em um município na região da Amazônia brasileira

To analyze the prevalence of asthma and asthma symptoms in students of two distinct age brackets residing in the city of Tangará da Serra, Brazil. Cross-sectional, population-based study of the prevalence of asthma in children from 6 to 7 years of age and adolescents from 13 to 14, using the standardized International Study of Asthma and Allergies in Childhood, phase 1 questionnaire, validated for use in Brazil. Students who responded affirmatively to question 2 (presence of wheezing in the preceding 12 months) were classified as suffering from asthma. The study comprised 3,362 students, of whom 1,634 (48.6%) were children and 1,728 (51.4%) were adolescents. Of the 1,634 children, 816 (49.9%) were male, and 818 (50.1%) were female. Of the 1,728 adolescents, 773 (45.0%) were male, and 955 (55.0%) were female. The prevalence of asthma among the children was 25.2%, whereas that among the adolescents was 15.9% (chi2 = 8.34; p = 0.00). The children presented higher prevalences of the following symptoms of asthma than did the adolescents: wheezing ever (54.3%), nocturnal dry cough (43.9%), wheezing in the preceding 12 months (25.2%), and from 1 to 3 attacks of wheezing in the preceding 12 months (19.1%). There were no differences between the two groups regarding physician-diagnosed asthma (approximately 4.5%). There were no statistical differences regarding the prevalence of asthma by gender in the two groups. Tangará da Serra has a high prevalence of asthma in children and adolescents, and this result is compatible with other studies carried out in Brazil and Latin America using the same methodology.

Longitudinal Study on the Development of Respiratory and Allergic Disorders Among Paris Birth Cohort Infants

ISEE-822 Objective: The Paris prospective birth cohort study was undertaken to determine the incidence of respiratory/allergic manifestations in Paris children up to the age of 6 and investigate the impact of behavioral/ environmental factors. This work describes the onset of respiratory/allergic outcomes in the first year of age. Materials and Methods: Data were collected by repeated self-administered standardized questionnaires. Questions concerned asthma-like symptoms, allergic rhinoconjunctivitis, atopic dermatitis (AD), food allergy, and infectious diseases. A discriminant analysis was used to separate wheezers from nonwheezers, and recurrent from infrequent wheezers. Results: Results are given for 1910 infants. AD, allergic rhinoconjunctivitis, and food allergy respectively occurred in 17%, 9%, and 3% of infants. The main respiratory symptoms were wheeze (22%), nocturnal dry cough (16%), and shortness of breath (4%). Wheeze onset mainly resulted from a respiratory infection. Lower respiratory tract infections (LRTI), bronchial obstructive symptoms, parental asthma, male gender, and AD increased risk of wheeze. Recurrent wheezers accounted for 20% of wheezers, and had signs of severity more frequently, together with associated bronchial obstructive symptoms. LRTI, bronchial obstructive symptoms, birth during spring, and AD discriminated between infrequent and recurrent wheezers. Conclusions: Descriptive epidemiology of respiratory/allergic symptoms is consistent with data from birth cohort studies. We highlighted a phenotype of recurrent wheeze, characterized by repeated LRTI, bronchial obstructive symptoms, and personal history of AD. Thanks to repeated questionnaires, detailed information on the occurrence of respiratory and allergic disorders was collected. Health data were prospectively recorded at frequent intervals so that the risk of recall bias was limited. Importantly, the study design was suitable for describing the inception and chronology of respiratory and allergic manifestations during infancy. Recurrent wheezers deserve to be followed-up very carefully because they could be at higher risk of asthma onset later in life, and be more susceptible to environmental risk factors.

Left-sided chest pain: a case report of intra-abdominal aetiology

A 44-year-old African-American male presented to the emergency department with progressive left-sided anterior chest pain of 1-month duration, which was rated six out of 10 in intensity. Associated symptoms included nocturnal dry cough and tenderness to touch. The patient's symptoms were relieved with ibuprofen.