Pediatric Cough Research Articles

An expert consensus on managing cough in Indian pediatric practice: airway disease education and expertise 2.0 (2024)

Cough in children is one of the most frequent presenting symptoms in health care settings. Coughing can significantly affect a child's sleep and level of activity, which often causes parents’ distress. Promptly addressing chronic cough may enhance the quality of life in children and reduce the considerable stress on parents. In 2017, airway disease education and expertise (ADEX) NEXT recommendations for diagnosis, management, and follow-up of persistent (chronic) cough were published. For the present work 27 modified Delphi consensus statements were prepared, and a survey was undertaken involving 30 expert pediatricians from across India. The opinions of the expert panel on the updates related to pediatric chronic cough awareness, diagnosis, and management were collected. Consensus was predetermined to be obtained if more than 75% of the participants agreed or remained neutral for the statement. All the statements were supported by the latest data from the literature search. All the statements reached consensus after an agreement of more than 75%. Consequently, all the opinions from experts were consolidated and expert recommendations were framed. Children presenting with cough should be treated in accordance with child-specific guidelines. The present expert recommendations can be utilized by pediatricians to make well-informed decisions when treating pediatric patients with cough. The management of cough in children should be determined by the underlying cause, where a prompt and efficient therapy can result in early resolution.

Role of Spirometry, Radiology, and Flexible Bronchoscopy in Assessing Chronic Cough in Children.

Chronic cough in children is a common and multifaceted symptom, often requiring a comprehensive approach for accurate diagnosis and effective management. This review explores the use of spirometry, radiology (chest X-rays and computed tomography (CT) scans), and flexible bronchoscopy in the assessment of chronic cough in children through current guidelines and studies. The strengths, clinical indications, and limitations of each modality are examined. Spirometry, radiology, and in some cases flexible bronchoscopy are integral to the assessment of chronic cough in children; however, a tailored approach, leveraging the strengths of each modality and guided by clinical indications, enhances diagnostic accuracy and therapeutic outcomes of pediatric chronic cough.

Effects of yupingfeng granules combined with pediatric lung heat cough asthma on serum inflammatory factors and T lymphocyte subsets in children with Mycoplasma pneumonia.

Effects of yupingfeng granules combined with pediatric lung heat cough asthma on serum inflammatory factors and T lymphocyte subsets in children with Mycoplasma pneumonia.

Discussing the Treatment of Pediatric Cough from the Perspective of the Liver

Discussing the Treatment of Pediatric Cough from the Perspective of the Liver

Rasch validation of the short form (8 item) PC-QoL questionnaire and applicability of use as a health state classification system for a new preference-based measure

BackgroundThe parent-proxy paediatric chronic cough quality of life questionnaire (PC-QoL) is a commonly used measure of spillover quality of life in parents of children with chronic cough. To date, spillover health utility in these parents is not routinely estimated largely due to the lack of a suitable instrument. Their perspective is not included in economic evaluations of interventions for their children. We explored developing a health state classification system based on the PC-QoL for measuring health utility spill over in this population.MethodsThis study included PC-QoL 8-item responses of 653 parents participating in a prospective cohort study about paediatric chronic cough. Exploratory factor analysis (EFA) and Rasch analysis were used to examine dimensionality and select potential items and level structure.ResultsEFA indicated that the PC-QoL had one underlying domain. Rasch analysis indicated threshold disordering in all items which improved when items were collapsed from seven to four levels. Two demonstrated differential item functioning (DIF) by diagnosis or ethnicity and were excluded from the final scale. This scale satisfied Rasch assumptions of local independence and unidimensionality and demonstrated acceptable fit to the Rasch model. It was presented to and modified by an expert panel and a consumer panel. The resulting classification system had six items, each with four levels.DiscussionThe PC-QoL can conform to a Rasch model with minor modifications. It may be a good basis for the classification system of a child cough-specific PBM. A valuation study is required to estimate preference weights for each item and to estimate health utility in parents of children with chronic cough.

Eosinophilic Cationic Protein and Immunoglobulin E: Unraveling Biomarkers in Chronic Pediatric Cough

Although the cough reflex is one of the essential protective mechanisms in the respiratory tract, it is considered a considerable health problem in adults and children when it becomes chronic and hypersensitive. However, the need for biomarkers for chronic cough in children and adults is critical. The problem with cough is also a severe symptom in hypersensitivity children. Respiratory infections are a considerable challenge for pediatricians, especially in allergic children. The term cough hypersensitivity syndrome, although introduced in adults, was questioned for children. Eosinophil cationic protein (ECP) is a promising marker for chronic cough but still needs to be validated and proved in clinical settings. In this review article, we aimed to discuss the possible role of ECP in connection to IgE for chronic cough in children.

Endotypes of Paediatric Cough—Do They Exist and Finding New Techniques to Improve Clinical Outcomes

Chronic cough is a common symptom of many childhood lung conditions. Given the phenotypic heterogeneity of chronic cough, better characterization through endotyping is required to provide diagnostic certainty, precision therapies and to identify pathobiological mechanisms. This review summarizes recent endotype discoveries in airway diseases, particularly in relation to children, and describes the multi-omic approaches that are required to define endotypes. Potential biospecimens that may contribute to endotype and biomarker discoveries are also discussed. Identifying endotypes of chronic cough can likely provide personalized medicine and contribute to improved clinical outcomes for children.

Pediatric cough as a symptom: Tips for management

Cough in children and adults is a commonly witnessed symptom that can be related to a serious underlying disease. It is a reflex phenomenon that protects the airways and lungs by eliminating mucus, inhaled irritants, pathogens, and particulates and further helps in clearing out the air spaces of accumulated secretions. However, cough in children and adults has some notable differences based on various parameters, including duration, symptoms witnessed, duration, and etiology. Therefore, the tools and processes commonly employed for evaluating cough in adults may not apply to pediatric patients. Furthermore, the management of cough, in general, should be based on the etiology instead of the underlying disease condition. There is a relative paucity of data related to pediatric cough in comparison to adult cough, making the management of cough challenging. This article provides a comprehensive review of cough management in children in Indian scenarios.

Managing of acute pediatric cough in Africa: prescription of cough suppressants and associated complications

Managing of acute pediatric cough in Africa: prescription of cough suppressants and associated complications

The Respiratory Microbiome in Paediatric Chronic Wet Cough: What Is Known and Future Directions.

Chronic wet cough for longer than 4 weeks is a hallmark of chronic suppurative lung diseases (CSLD), including protracted bacterial bronchitis (PBB), and bronchiectasis in children. Severe lower respiratory infection early in life is a major risk factor of PBB and paediatric bronchiectasis. In these conditions, failure to clear an underlying endobronchial infection is hypothesised to drive ongoing inflammation and progressive tissue damage that culminates in irreversible bronchiectasis. Historically, the microbiology of paediatric chronic wet cough has been defined by culture-based studies focused on the detection and eradication of specific bacterial pathogens. Various 'omics technologies now allow for a more nuanced investigation of respiratory pathobiology and are enabling development of endotype-based models of care. Recent years have seen substantial advances in defining respiratory endotypes among adults with CSLD; however, less is understood about diseases affecting children. In this review, we explore the current understanding of the airway microbiome among children with chronic wet cough related to the PBB-bronchiectasis diagnostic continuum. We explore concepts emerging from the gut-lung axis and multi-omic studies that are expected to influence PBB and bronchiectasis endotyping efforts. We also consider how our evolving understanding of the airway microbiome is translating to new approaches in chronic wet cough diagnostics and treatments.

Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia.

Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation. Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x-ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada-full-position-statement. Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended. High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults. Red flags that indicate serious underlying conditions requiring investigation or referral should be identified. Early and effective treatment of chronic wet/productive cough in children is critical. Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted. If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

Does routine spirometry impact on clinical decisions and patient-related outcome measures of children seen in respiratory clinics: an open-label randomised controlled trial

IntroductionThere is limited evidence on the efficacy of using spirometry routinely in paediatric practice for improving outcomes.ObjectiveTo determine whether the routine use of spirometry alters clinical decisions and patient-related outcome...

Therapeutic principles and unmet needs in the treatment of cough in pediatric patients: review and expert survey

BackgroundThere are evidence gaps in the management of pediatric cough, particularly for acute pediatric cough. This study had two aims: to identify therapeutic principles and unmet needs in the treatment of cough in pediatric patients (internationally), and to consider the evidence required to address these unmet needs.MethodsA MEDLINE/PubMed database search was performed to identify articles describing therapeutic principles in the treatment of pediatric cough. An online survey of international pediatric cough experts was conducted, with questions on the definitions, diagnosis, treatment, and unmet needs in pediatric cough management.ResultsCough guidelines have differing definitions of pediatric patients (≤12–18 years), acute pediatric cough (< 2–3 weeks), and chronic pediatric cough (> 4–8 weeks). Similarly, among 18 experts surveyed, definitions varied for pediatric patients (≤10–21 years), acute pediatric cough (< 3–5 days to < 6 weeks), and chronic pediatric cough (> 2–8 weeks). Guidelines generally do not recommend over-the-counter or prescription cough medicines in acute pediatric cough, due to lack of evidence. In the expert survey, participants had differing opinions on which medicines were most suitable for treating acute pediatric cough, and noted that effective treatments are lacking for cough-related pain and sleep disruption. Overall, guidelines and experts agreed that chronic pediatric cough requires diagnostic investigations to identify the underlying cough-causing disease and thereby to guide treatment. There are unmet needs for new effective and safe treatments for acute pediatric cough, and for randomized controlled trials of existing treatments. Safety is a particular concern in this vulnerable patient population. There is also a need for better understanding of the causes, phenotypes, and prevalence of pediatric cough, and how this relates to its diagnosis and treatment.ConclusionsWhereas pediatric cough guidelines largely align with regard to the diagnosis and treatment of chronic cough, there is limited evidence-based guidance for the management of acute cough. There is a need for harmonization of pediatric cough management, and the development of standard guidelines suitable for all regions and patient circumstances.

Retracted: Assessment of Clinical Diagnostic Efficacy of Pulmonary Function Test Based on DBN-SVM of Pediatric Asthma and Cough Variant Asthma.

[This retracts the article DOI: 10.1155/2022/1182114.].

Incidence and Prevalence of Cough in a Rural Health System: A 20-Year Study.

Understanding the cough population is critical to addressing clinical needs and gaps in best practice. We sought to characterize and stratify cough patients with the hypothesis that there are opportunities to improve access to care in our health system and characterize the population. Following institutional review board exempt status, a retrospective electronic record review was performed on all patients coded with ICD-9 786.2 or ICD-10 is R05 from January 1, 2001 through December 31, 2020 at our health system. Inclusion criteria were one or more visits for cough. The subgroup with more than one visit in each of 2 years was classified as multiple encounters. Patients were characterized by sex, age at first cough encounter, number of cough encounters, smoking status, and insurance status. Results were stratified by year, calculating frequencies, and percentages. There were 302,284 unique patients diagnosed with cough, among 1,764,387 patients seen in our health system, representing an average incidence of 3.0% (2.7%-3.7%) and prevalence of 4.9% (3.1%-5.6%). New single encounter cough patients totaled 179,963, and new multiple encounter cough patients totaled 122,321. Of the 39,828,073 total encounters, there were 469,802 for new or existing cough (1.17%-1.73% annually). The age at initial presentation demonstrated 36.5% seen <10 years old, with an even distribution over the remaining decades of life. The majority were seen for cough once, but 23.8% of group two patients had two or more visits for cough in a year. We demonstrate a lower-than-expected incidence and prevalence of cough in our health population, suggesting challenges with access to care when compared to 10% prevalence and 3% of encounters previously documented in the literature. The study also provides a platform to explore the importance of pediatric cough, as well as population health and the longitudinal journey of cough patients in underserved areas. 3 Laryngoscope, 133:1191-1196, 2023.

An intelligent prediagnosis system for disease prediction and examination recommendation based on electronic medical record and a medical-semantic-aware convolution neural network (MSCNN) for pediatric chronic cough.

BackgroundDue to the phenotypic similarities among different pediatric respiratory diseases with chronic cough, primary doctors often misdiagnose and the misuse of examinations is prevalent. In the pre-diagnosis stage, the patients' chief complaints and other information in the electronic medical record (EMR) provide a powerful reference for respiratory experts to make preliminary disease judgment and examination plan. In this paper, we proposed an intelligent prediagnosis system to predict disease diagnosis and recommend examinations based on EMR text.MethodsWe examined the clinical notes of 178,293 children with chronic cough symptoms from retrospective EMR data. The dataset is split into 7:3 for training and testing. From the testing set, we also extract 5% of samples for validation. We proposed a medical-semantic-aware convolution neural network (MSCNN) framework that can accomplish two downstream tasks from the same medical language model through transfer learning. First, a medical language model based on the word2vec algorithm was built to generate embeddings for the text data. Then, text convolutional neural network (TextCNN) was used to build models for disease prediction and examination recommendation.ResultsWe implemented 5 algorithms for disease prediction. In the disease prediction task, our algorithm outperformed the baseline methods on all metrics, with a top-1 accuracy (AC) of 0.68 and a top-3 AC of 0.923 on the testing set. By adding data enhancement, the top-3 AC reached 0.926. In the examination recommendation task, the overall AC on the testing set was 0.93 and the macro average (MA) F1-score was 0.88. The average area under the curve (AUC) on the training set was 0.97 while on the testing set it was 0.86.ConclusionsWe constructed an intelligent prediagnosis system with an MSCNN framework that can predict diseases and make examination recommendations based on EMR data. Our approach achieved good results on a retrospective clinical dataset and thus has great potential for the application of automated diagnosis assist in clinical practice during pre-diagnosis stage, which will provide help for primary level doctors or doctors in basic-level hospitals. Due to the generality of the proposed framework, it can be straight forwardly extended to prediagnosis for other diseases.

Assessment of Clinical Diagnostic Efficacy of Pulmonary Function Test Based on DBN-SVM of Pediatric Asthma and Cough Variant Asthma.

The diagnosis of asthma depends on the unprejudiced proof of the varying airflow obstruction. The pulmonary function tests are carried out to evaluate the clinical value of different types of respiratory diseases in children or infants. This study is focused on the clinical evaluation of the pulmonary function tests in the diagnosis of pediatric asthma and cough variant asthma. A differential diagnosis method for chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap with complementary diagnostic value is proposed. For the pulmonary function tests, the COPD gene dataset was selected and feature selection was performed using the DBN-SVM scoring method. For analysis and comparison, the differential diagnosis models were built using ROC curves for the accuracy of the deep belief network model and the support vector machine model. The sensitive features associated with COPD and ACO classification using the deep belief network model were found to be in good agreement with known clinical diagnostic strategies. The clinical diagnosis tests for pulmonary pediatric asthma and cough variant asthma were conducted on two groups of children, with both groups containing a basis of comparison. 80 cases of pediatric asthma and cough variant asthma were admitted from 2013 to 2014 and 80 cases of children with a healthy physical examination. The results of the two groups were compared. The results showed that the levels of FEV1, PEF, and FVC were significantly lower (P < 0.05), in healthy children, and FEV1/FVC%, RV, and RV/TCL% were significantly higher (P < 0.05) in children with asthma and cough variant asthma during acute exacerbation and chronic persistence. There were no statistically significant differences in the duration of clinical remission (P > 0.05). Thus, the study suggests that confirmed cases of the diagnosis of pediatric asthma and cough variant asthma by pulmonary function tests were significantly higher than those of conventional tests (P < 0.05). From this study, we can conclude that pulmonary function tests can accurately diagnose pediatric asthma and cough variant asthma, and also accurately reflect the development of the child's disease, which is of high clinical value.

Telepractice Considerations for Evaluation and Treatment of Voice Disorders: Tailoring to Specific Populations

The aim of this clinical focus article is to provide recommendations for implementation of telepractice services for the evaluation and treatment of voice disorders and to use case examples to highlight the advantages of this modality of service delivery. In this clinical focus article, key factors for successful telepractice evaluation and treatment of voice and related disorders are discussed relative to clinical outcome measures. Case examples of telepractice voice therapy are described for a pediatric, transgender, and chronic cough client including associated acoustic, auditory-perceptual, and quality-of-life treatment outcomes. Acoustic, perceptual, and quality-of-life outcome measures demonstrated functional voice improvements after treatment using the telepractice modality. The pediatric client showed decreased perceptual voice strain and increased speech intelligibility. The transgender client showed increased habitual speaking fundamental frequency (pitch) and quality of life. The chronic cough client showed improved vocal hygiene and reduced cough severity. A review of the literature shows comparable outcomes for in-person and telepractice voice therapy, but special considerations must be made to ensure therapeutic success. We present three representative types of voice cases that illustrate implementation of voice evaluation and treatment using the telepractice modality. In all three cases, the clients' personal therapeutic goals were achieved without needing to travel to the clinic. Furthermore, asynchronous practice opportunities were found to be positive byproducts of using the telepractice modality.

Development and technical validation of a smartphone-based pediatric cough detection algorithm.

IntroductionCoughing is a common symptom in pediatric lung disease and cough frequency has been shown to be correlated to disease activity in several conditions. Automated cough detection could provide a noninvasive digital biomarker for pediatric clinical trials or care. The aim of this study was to develop a smartphone‐based algorithm that objectively and automatically counts cough sounds of children.MethodsThe training set was composed of 3228 pediatric cough sounds and 480,780 noncough sounds from various publicly available sources and continuous sound recordings of 7 patients admitted due to respiratory disease. A Gradient Boost Classifier was fitted on the training data, which was subsequently validated on recordings from 14 additional patients aged 0–14 admitted to the pediatric ward due to respiratory disease. The robustness of the algorithm was investigated by repeatedly classifying a recording with the smartphone‐based algorithm during various conditions.ResultsThe final algorithm obtained an accuracy of 99.7%, sensitivity of 47.6%, specificity of 99.96%, positive predictive value of 82.2% and negative predictive value 99.8% in the validation dataset. The correlation coefficient between manual‐ and automated cough counts in the validation dataset was 0.97 (p < .001). The intra‐ and interdevice reliability of the algorithm was adequate, and the algorithm performed best at an unobstructed distance of 0.5–1 m from the audio source.ConclusionThis novel smartphone‐based pediatric cough detection application can be used for longitudinal follow‐up in clinical care or as digital endpoint in clinical trials.

Over-the-Counter Cough and Cold Medications Danger in Children

Source: Halmo LS, Wang GS, Reynolds KM, et al. Pediatric fatalities associated with over-the-counter cough and cold medications [published online ahead of print October 4, 2021]. Pediatrics. 2021: e2020049536; doi.10.1542/peds.2020-049536Investigators from multiple institutions conducted a study to describe fatalities due to ingestion of cough and cold medications (CCMs) in children following a 2008 FDA recommendation to not use these products in children <2 years old and a labelling change by drug manufacturers to not use in children <4 years old. Cases were identified by the Pediatric Cough and Cold Safety Surveillance System that collected data on ingestions from multiple sources, including poison control centers, FDA reporting systems, and media reports. Cases were children <12 years old who died after oral exposure to 1 or more of 8 index ingredients (brompheniramine, chlorpheniramine, dextromethorphan, diphenhydramine, doxylamine, guaifenesin, phenylephrine, or pseudoephedrine) between 2008 and 2016. All case data available and autopsy reports were reviewed by an expert panel that classified identified fatalities as related, potentially related, or unrelated to CCMs; some cases could not be classified. The primary study outcome was a fatality related or potentially related to CCMs. Deaths were judged to be from therapeutic, nontherapeutic, or unknown intent, and by dose (therapeutic, supratherapeutic, or unknown). The expert panel also conducted a root cause analysis to document other factors that might have contributed to the child’s death.There were 7,983 cases of adverse events associated with CCMs identified by the Pediatric Cough and Cold Safety Surveillance System. Among these were 188 fatalities (2.3%). After review, 40 cases were judged to be related or potentially related to an index ingredient and included in the analysis. Overall, 24 cases (60%) occurred in children <2 years old and 29 (72.5%) in those <4 years old; 26 deaths (65%) occurred in boys. The CCM was administered by a parent or caregiver in 28 cases. All 3 cases in which the child self-administered the CCM involved a solid adult-formulation diphenhydramine product. Overall, 22 fatalities (55%) were from nontherapeutic use, 6 (15%) from therapeutic use, and in 12 cases therapeutic intent could not be determined. Dose was judged to be supratherapeutic in 8 cases (20%) and could not be determined in 32. At least 1 additional ingredient besides the index CCM was involved in 17 fatalities; the most common additional ingredients were opioids (N = 11). Among the 40 fatalities, 7 (17.5%) were related to use of a CCM to sedate a child, and 6 (15%) were from the use of a CCM to murder the child.The authors conclude that pediatric fatalities associated with CCMs primarily occur in younger children and after intentional nontherapeutic administration by a caregiver.Dr Alissa has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Adverse drug events in children associated with CCM have been the center of discussion for more than a decade.1 Numerous articles have been written about the risk of CCM ingestions for therapeutic and nontherapeutic intent, in therapeutic and supratherapeutic doses.2 The consensus in these reports is that no fatality involves a therapeutic dose of CCM.2The misuse of over-the-counter medications including diphenhydramine has become a worldwide health concern.3 Palmer et al found that exposures to diphenhydramine-only products are the most common type of exposure that leads to adverse events associated with CCM in children.4 Despite international and national warnings, physicians frequently overprescribe and parents overuse CCM for upper respiratory tract infection in young children.5CCM were a major category of pharmaceuticals maliciously administered to children less than 2 years old in a retrospective database study conducted by researchers at the University of Colorado. Do caregivers administer a sedating agent simply as a break from the responsibilities of childcare?6The current study’s strength is the multiple national sources used to collect the data. Including specific index ingredients also is a strength of the study. The main limitation is the lack of information about the group of children who died due to the ingestion of an unknown dose of CCM.CCM remains dangerous for all children, especially those <2 years old. More restricted use is recommended.Physicians consider prescribing for children >12 months of age a sweet alternative to CCMs that is safe and efficacious: honey. (See AAP Grand Rounds. 2013;29[2]:14.)7