Non-specific Chronic Cough Research Articles

Systematic review and meta-analysis: proton pump inhibitors slightly decrease the severity of chronic cough

The Montreal consensus recognizes chronic cough as an extra-esophageal manifestation of gastroesophageal reflux disease. We performed a meta-analysis to assess the effects of acid-suppressive medications in adults with non-specific chronic cough. The protocol was registered on PROSPERO (CRD42022368769). Placebo-controlled randomized trials evaluating the impact of acid-suppressive medications on persistent cough were included. The systematic search was performed on the 1st of November 2022 in three databases. A random-effects model was used for the calculations. The effect size was the standardized mean difference (SMD) with 95% confidence interval (CI). A total number of 11 double-blinded placebo-controlled randomized trials were included in the meta-analysis. Data showed that compared to placebo, PPIs decreased the severity of cough (SMD 0.33; CI 0.05; 0.61). Therapeutic response was not different in patients with non-specific chronic cough only, compared to those with laryngopharyngeal reflux. Prolonged treatment durations did not result in greater symptomatic improvement, with SMD 0.33 (CI − 0.22; 0.88), 0.31 (CI − 1.74; 2.35), 0.32 (CI − 0.29; 0.93) and 0.34 (CI − 0.16; 0.85), following 4, 6, 8 and 12 weeks of treatment, respectively. The pooled analysis of the improvement in quality of life with PPIs found an SMD of 0.39 (CI − 0.51; 1.29). PPIs mildly decrease the severity of non-specific chronic cough, irrespective of treatment duration.

Factors influencing behavioral cough suppression therapy in children with nonspecific chronic cough.

Behavioral cough suppression therapy (BCST) with a speech-language pathologist is a common treatment for chronic nonspecific cough (a.k.a., tic cough) in children. Yet, the outcomes and duration of pediatric BCST have eluded formal investigation. This study examined whether BCST improves cough in children with nonspecific cough and factors that predict the course of treatment. Additionally, the cough characteristics and comorbidities associated with the condition were examined. A retrospective, observational cohort design was utilized. Cough characteristics, medical history, and BCST treatment details and outcomes for 151 children were extracted from the electronic medical record of a large outpatient pediatric otolaryngology clinic. Cough was dry and onset unaccompanied by illness in most cases. Roughly half of patients reported gradual onset and cough proceeded by tickle. On average, patients experienced symptoms for 19 months (SD = 20.09) before diagnosis. Rates of comorbid General Anxiety Disorder were elevated compared to pediatric norms. Additionally, high rates of asthma (22.1%), reflux (62.3%), and disordered sleep breathing (19.2%) were observed. Common findings on laryngoscopy included interarytenoid edema and erythema. Vocal fold changes were observed in 22.9% of children. BCST reduced cough in 92.5% of patients following an average of 1.7 sessions. Comorbid behavioral health diagnoses (p = 0.013) or induced laryngeal obstruction symptoms (p = 0.025) were significant predictors of increased therapy sessions. Cough proceeded by tickle significantly predicted fewer sessions in therapy (p = 0.011). Although randomized clinical trials are needed, these data suggest that BCST is a low-risk, effective treatment for children with nonspecific cough.

Increased serum eosinophilic cationic protein in children with nonspecific chronic cough.

Increased serum eosinophilic cationic protein in children with nonspecific chronic cough.

Etiology analysis of nonspecific chronic cough in children of 5 years and younger.

This study aims to analyze the etiology of nonspecific chronic cough in children of 5 years and younger, in order to improve the diagnostic and treatment levels of pediatricians for nonspecific chronic cough in young children.The clinical data of 85 cases of children of 5 years old and below, who suffered from nonspecific chronic cough between the period of January 2015 and August 2016 were retrospectively analyzed.The etiology distribution of 85 cases of children with nonspecific chronic cough were as follows: 27 cases had cough variant asthma (31.8%), 32 cases had upper airway cough syndrome (37.6%), 16 cases had cough after infection (18.8%), 3 cases had gastroesophageal reflux cough (3.5%), 2 cases had allergic cough (2.4%), and 5 cases had unknown causes of cough (5.9%).The main composition ratio of the etiology of chronic cough in children of 5 years old and below is as follows (in sequence): upper airway cough syndrome, cough variant asthma, and post infection cough.

Aetiological Approach to Patient with Non- Specific Chronic Cough

Chronic cough is a problem commonly encountered by the practicing physicians. Definitive treatment depends upon identifying the cause of cough4.To develop an appropriate algorithm for diagnosis of non-specific chronic cough a Prospective case-control study was carried out in Asthma Centre,NIDCH, Mohakhali, Dhaka during the period of January,2000 to December,2001. Eighty two patients with history of cough for 3 weeks or more duration were taken in group A.The ages ranged from 11 to 68 years with mean age 35.5 ± 12.0 years. There were 43 males and 39 females. Equal number of subjects having no cough were taken as control (group B).The age of control subjects ranged from 11 to 68 years with mean age 35.6 ± 11.9 years. Diagnosis was made in all patients. PNDS was found in 41(50%), PNDS with cough variant asthma in 19(23.2%),cough variant asthma alone in 10(12.2%),GERD singly in 2(2.4%).In control group, only 5 (6.1%) persons were diagnosed as PNDS who had almost all features of PNDS except cough. In this studuy, PNDS alone and in combination with cough variant asthma were common causes of chronic cough.TAJ 2012; 25: 1-7

KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea.

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.

Cough in Children

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4–8weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Tos en el niño

Cough during childhood is very common, and is one of the most frequent reasons for consultation in daily pediatric practice. The causes differ from those in adults, and specific pediatric guidelines should be followed for correct diagnosis and treatment. The most common cause of cough in children is viral infection producing “normal cough”, but all children with persistent cough, i.e. a cough lasting more than 4-8weeks or “chronic cough”, must be carefully evaluated in other to rule out specific causes that may include the entire pediatric pulmonology spectrum. The treatment of cough should be based on the etiology. Around 80% of cases can be diagnosed using an optimal approach, and treatment will be effective in 90% of them. In some cases of “nonspecific chronic cough”, in which no underlying condition can be found, empirical treatment based on the cough characteristics may be useful. There is no scientific evidence to justify the use of over-the-counter cough remedies (anti-tussives, mucolytics and/or antihistamines), as they could have potentially serious side effects, and thus should not be prescribed in children.

Voice Treatment for Nonspecific Chronic Cough and Paradoxical Vocal Fold Motion Disorder in Children

Seminars in Speech and Language, Volume 34, No. 1, is devoted to types and treatment of voice disorders in children. School speechlanguage pathologists (SLPs) may sometimes find it difficult to put children with voice problems on their caseloads because they must show how the disorder affects academic performance. The authors in this issue of Seminars make clear that pediatric voice disorders do impact academic performance. Voice disorders are associated with school absenteeism; decreased participation in academic classes, physical education, and extracurricular activities; and negative attention from classmates and school personnel, thus impacting academic performance and social well-being. Some voice disorders, such as vocal nodules, are familiar to SLPs; others, such as paradoxical vocal fold motion disorder (PVFMD) and nonspecific chronic cough (NSCC), are less familiar. In their article in this issue, Gallena and Kerins describe the nature, assessment, and treatment of NSCC and PVFMD.

Nonspecific Chronic Cough and Paradoxical Vocal Fold Motion Disorder in Pediatric Patients

Paradoxical vocal fold motion disorder and nonspecific chronic cough are laryngeal disorders that are newly identified within the speech-language pathologist's scope of practice. Recognizing the signs and symptoms of these disorders and providing practical and evidenced-based treatment is the focus of this article. Defining the role of the speech-language pathologist in treating these low incidence yet quickly remediated disorders provides the pediatric or school-based speech-language pathologist a unique service delivery challenge. A model that utilizes an interdisciplinary team to provide efficient and effective treatment outcomes is discussed.

Tonsillolith: a panoramic radiograph presentation.

Tonsilloliths are calcifications within a tonsillar crypt, involve primarily the palatine tonsil caused by dystrophic calcification as a result of chronic inflammation. Tonsilloliths are very uncommon and are microscopic. Tonsillar concretions sometimes produce symptoms which include non-specific chronic halitosis, irritable cough, dysphagia, otalgia and foreign body-like sensation or foul taste. Patients with tonsillolithiasis may also be asymptomatic, with their lesions being discovered incidentally on panoramic radiographs. This article presents an unusual case of multiple bilateral and asymptomatic tonsilloliths which were found during a routine panoramic radiographic examination.

Review: Evidence on PPIs for nonspecific chronic cough in adults with gastroesophageal reflux disease is inconsistent

Source Citation Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA. Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev. 2011;(1):CD004823. 21249664

Etiological analysis of the children with non-specific chronic cough in Fuzhou area of Fujian province

Chronic cough in children is a common pediatric symptom with complex causes and its diagnosis is difficult; chronic cough affects the life of children in both physical and mental health and also learning. Therefore this study aimed to investigate the causes of chronic cough in children in Fuzhou area of Fujian province. Data were collected from 364 children with chronic cough who visited the asthma specialist clinic of Children's Hospital of Fuzhou, Fujian Province from March 2009 to April 2010. The diagnosis was made according to Guideline for Diagnosis and Treatment of Chronic Cough in Pediatrics published in 2008. Among the patients, 241 were boys and 123 girls. The patients were divided into 3 age groups: group 1, 1 to 3 years old (infants and young children group, n = 75); group 2, 4 to 6 years old (pre-school group, n = 215); and group 3, over 7 years (school-age group, n = 74), the mean age was (4.8 ± 1.1) years (3 months to 14 years), course of the illness was (4.5 ± 1.8) months (4 weeks to 38 months). Mycoplasma pneumoniae was detected by Enzyme-linked immunosorbent assay (ELISA). The causes of chronic cough were as follows: 171 cases (46.98%) had cough variant asthma; 104 cases (28.57%) had upper airway cough syndrome; 58 cases (15.93%) had respiratory infections; 17 cases (4.67%) had gastroesophageal reflux; 3 cases (0.82%) had foreign bodies. Totally 9 cases (2.47%) had chronic cough associated with 3 causes; 56 cases (15.38%) had 2 causes and 299 cases (82.14%) had single cause. The main causes of cough in the group of pre-school children were cough variant asthma and upper airway cough syndrome. The proportion of the upper airway cough syndrome in school-age children group was the highest among the 3 age groups, which is flowed by cough variant asthma. The causes of chronic cough in children were cough variant asthma, upper airway cough syndrome, respiratory infections, cough after infection, gastroesophageal reflux and foreign bodies in Fuzhou area of Fujian province. Children with chronic cough in different age groups had different etiology, in about 18% of the children the etiology of chronic cough was associated with 3 or 2 causes, indicating that the causes of chronic cough in children are multifactorial.

The Cochrane Library and the Treatment of Chronic Cough in Children: An Overview of Reviews

AbstractBackgroundChronic cough is a universal condition of childhood that affects approximately one in ten children. Chronic cough can be either specific (‘wet’ cough or other symptoms concurrently present) or nonspecific (‘dry’ cough in the absence of other symptoms). Compared to adults, specific and non‐specific chronic cough in children differs in terms of both aetiology and treatment, and the methods used to treat chronic cough in adults may actually be harmful for children.ObjectiveThis overview of reviews synthesizes the evidence currently in the Cochrane Library Database of Systematic Reviews (CDSR) in order to answer the following question: in the treatment of childhood specific and non‐specific chronic cough, which pharmacologic or non‐pharmacologic treatments improve cough symptoms and decrease adverse events?MethodsThe Cochrane Database of Systematic Reviews was searched using the terms ‘specific cough’, ‘non‐specific cough’, ‘moist cough’ and ‘chronic cough’ in the record title for all systematic reviews examining pharmacologic or non‐pharmacologic interventions for the treatment of chronic cough in children. Data were extracted, complied into tables, and synthesized using qualitative and quantitative methods.Main ResultsSix reviews (five on non‐specific cough and one on specific cough) were indentified for inclusion. For non‐specific cough, one review found that very high‐dose inhaled corticosteroids were effective in reducing non‐specific cough (RR: 2.04; 95% CI: 1.10, 3.77), but this treatment was not advocated. To date, there is no evidence that anti‐histamines, β2 agonists, gastro‐oesophageal reflux treatments or leukotriene receptor antagonists are efficacious for the treatment of non‐specific chronic cough. For specific cough related to isolated wet cough, there was significant clinical improvement when children were treated with antibiotics (RR: 2.42; 95% CI: 1.65, 3.53). Limited data were available for adverse events associated with any of the treatment options.Authors' ConclusionsThe paucity of RCT evidence in the management of children with chronic cough is striking. Five systematic reviews on interventions for non‐specific cough do not support an empirical treatment approach. One systematic review on interventions for specific cough found some support for the use of antibiotics. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration

Honey and lozenges for children with non-specific cough.

Chronic non-specific cough is a chronic, dry cough of in the absence of identifiable respiratory disease or known aetiology. Although it is usually not reflective of an underlying severe illness, it does cause significant morbidity, and as such relief from it is often sought. The use of honey and lozenges to soothe upper respiratory tract irritation is common, inexpensive, and potentially more effective in treating the symptoms than pharmacological interventions. To evaluate the efficacy of honey and/or lozenges in the management of children with chronic non-specific cough. The Cochrane Airways Group searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, OLDMEDLINE, and EMBASE databases in October 2008. All randomised controlled trials comparing honey or lozenges with a placebo in treating children with chronic non-specific cough. The results of the searches were assessed according to the pre-determined criteria. None of the trials identified by the searches were eligible for inclusion, leaving no data available for analysis in this review. The search did not provide any applicable randomised controlled trials that investigated the efficacy of honey and lozenges in treating children with non-specific chronic cough. Data from acute studies suggest a potential role for honey in relieving cough, but whether this is applicable to chronic cough is unknown. Clinically, this review was unable to provide any justifiable recommendation for or against honey and/or lozenges due to the lack of evidence. The absence of applicable studies highlights the need for further research into the area of treating children with chronic non-specific coughs with honey and/or lozenges. These treatments are not recommended when managing very young children (as lozenges are a potential choking hazard, and honey may cause infant botulism in children under 1 year of age).

Chronic non-specific cough in children

Non-specific chronic cough refers to cough of more than 4 weeks duration with no symptoms or signs suggestive of a likely underlying problem. Management of children with chronic cough includes: an evaluation for these symptoms and signs; a chest radiograph and spirometry (where age-appropriate); as well as an assessment of environmental factors (in particular tobacco smoke), parental concerns and expectations. As the aetiology and management of cough in children differs greatly to that in adults, the empirical approach commonly used in adults is unsuitable for children. Treatment for chronic cough in children should be based on aetiology. Over-the-counter and prescription medications are ineffective and should be rarely used for the symptomatic relief of cough. Because of the favourable natural history of non-specific cough, if medication trials are undertaken, a ‘positive’ response should not be assumed to be due to the medication tried. Children should be re- assessed within the expected timeframe of response to therapy. This article reviews the management of children with cough, focusing on non-specific cough.

Inhaled corticosteroids for non-specific chronic cough in children

Cough in isolation of other clinical features is known as non-specific cough, which has been defined as non-productive cough in the absence of identifiable respiratory disease or any known aetiology. In children with non-specific cough the possibility of asthma being the underlying disorder is often raised (so called cough variant asthma). The proponents of cough variant asthma suggest a therapeutic trial of medications usually used to treat asthma. To determine the efficacy of inhaled corticosteroids in non-specific cough in children over the age of two years. Searches were conducted on Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. Searches were current as of March 2004. All randomised (randomised and quasi-randomised) controlled clinical trials in which an inhaled corticosteroid (beclomethasone (BDP), fluticasone (FP), triamcinalone (TAA) or any other corticosteroid) were given for cough in children over two years of age were included. Two review authors independently assessed articles for inclusion and methodological quality. Data from trials was extracted by both review authors and entered into the Cochrane Collaboration software program RevMan Analyses 1.0.2. Two trials met the inclusion criteria (123 participants). One compared inhaled beclomethasone dipropionate (400 micrograms per day) with placebo and the other compared fluticasone propionate (2 mg per day for 3 days followed by 1 mg per day for 11 days) with placebo. Both studies used metered dose inhalers via a spacer. With the lower dose of inhaled corticosteroid there was no significant difference between the beclomethasone and placebo groups. With the higher dose there was a significant improvement in nocturnal cough frequency after two weeks in children presenting with persistent nocturnal cough. However, a significant but smaller improvement was also seen with placebo. In one study beclomethasone dipropionate (400 micrograms per day) was no different from placebo in reducing the frequency of cough measured objectively or scored subjectively. There might be a small improvement with very high-dose inhaled corticosteroid but the clinical impact of this is unlikely to beneficial.

Inhaled beta2-agonists for non-specific chronic cough in children

The pathophysiology of so called 'cough variant asthma' has not received a great deal of research interest and opinion lies divided as to whether it is really asthma or not. The proponents of cough variant asthma suggest a therapeutic trial of medications usually used to treat asthma To determine the effectiveness of inhaled ss2 agonists in non-specific chronic cough in children over the age of 2 years. The Cochrane Airways Group database (including MEDLINE, EMBASE and CINAHL) and the Cochrane Controlled Trials Register (CCRT) were searched. Additional searching included hand searching of medical journals through the Cochrane Collaboration, references, references of references listed in primary sources and personal communication with authors. In addition "Grey literature" including theses, internal reports, non-peer reviewed journals were sought. All randomised (randomised and quasi-randomised) controlled clinical trials in which inhaled ss2 agonists were given for chronic cough in children over 2 years of age were included. Two reviewers independently assessed articles for inclusion and methodological quality. Data for trials of salbutamol versus placebo were extracted by both reviewers and entered into the Cochrane Collaboration software program Review Manager, version 4.2 In children presenting with isolated chronic cough there was no significant difference between salbutamol treated group and placebo group. Salbutamol was no different from placebo in reducing the frequency of cough measured objectively or scored subjectively.