Upper Airway Cough Syndrome in 103 Children

Upper Airway Cough Syndrome in 103 Children

Chronic cough is a common and debilitating complaint in children, representing one of the most frequent reasons for parents to seek medical advice. Although there are diverse chronic cough morbidities in different countries, upper airway cough syndrome (UACS) is a major cause of childhood chronic cough. In China, UACS is only less frequent than cough-variant asthma and accounts for 24.71% of chronic cough. This study aimed to determine the pathogenetic constituents and factors affecting UACS in children of different age groups, and to identify clinical clues for diagnosing UACS and a method for curative effect evaluation.

The study was conducted from January to November 2013 at Children’s Hospital, Capital Institute of Pediatrics, Beijing, China. A total of 103 children with UACS whose chief complaint was chronic cough were studied. According to their age, children with UACS were divided into three groups: nursing children (0–3 years), pre-school children (>3 to <6 years), and school-age children (≥6 years). The study analyzed the differences in pathogenetic constituents and factors affecting UACS in children. The effect of UACS treatment was evaluated by the visual analog scale (VAS) and an objective examination. Chi-squared test and analysis of variance were performed with the SPSS 19.0 statistical software.

The results showed a high incidence of UACS in school-age children. Rhinitis with adenoid hypertrophy was the main cause of 103 suspected UACS cases. Adenoidal hypertrophy was the major cause of UACS in the pre-school children group, while rhinitis was the major reason in the nursing children and school-age children groups. Among the 103 children, there were 45 allergen-positive children, with no significant difference among different age groups. VAS scores in the different disease groups after treatment were lower than those before treatment (all P<0.01). VAS scores in different disease groups showed significant differences, except for 12 vs. 24 weeks after treatment (P=0.023). Different age groups had different secondary complaints.

The study concluded that there are different pathogeneses in different UACS age groups. Clinical treatment efficacy of children with UACS can be evaluated by the VAS combined with an objective examination. It is recommended that the course of treatment should be 12 weeks.

The pathogenesis of chronic cough in children is not the same as that in adults, and differs among various age groups. In this study, rhinitis with adenoid hypertrophy was the major pathogenesis of chronic cough among 103 children with UACS. Children suffered from different pathogeneses in different age groups. Rhinitis was the major pathogenesis in the nursing children and school-age children groups, while it was adenoid hypertrophy in the pre-school children group. This finding clearly showed that inflammation and/or mechanical obstruction were two major causes of UACS in children. As children became older in the study, the diagnostic frequency of rhinitis and nasosinusitis markedly increased in the school-age children group compared with the pre-school children group and nursing children group. Furthermore, the diagnostic frequency of adenoid hypertrophy showed a related decrease.

Allergic rhinitis is one of the most common nasal diseases which causes UACS in children. The mechanism of continuously inhaled allergens causing coughing is relatively clear. There were no significant differences in allergic factors among the different age groups, which indicated that allergic disease is an important causal factor for UACS in children of different ages. Regardless of the children’s age, anti-allergenic therapy is necessary.

The process of treatment for UACS in children is also a process of making a clear diagnosis. According to the American College of Chest Physicians, during the diagnosis and treatment process of non-specific chronic cough, attention should be paid to the expectation of children’s parents. Furthermore, they emphasize the importance of follow-up and re-evaluation (i.e., observation, waiting, and follow-up).

The study found that the VAS scores were significantly different at different times before and after treatment among the different disease groups. Therefore, using standard treatment to improve UACS in children is a gradual process. Drug treatment of most children lasted approximately 12 weeks. Therefore, waiting and observation lasted from 12 to 24 weeks after treatment. This suggested that, for most children with UACS, standard drug treatment began to take effect from 2 weeks after treatment, and 12 weeks after treatment was the end of treatment.

For a long time, UACS in children was attributed to “non-specific cough” and always lacked specific clinical symptoms. Common complications (besides cough) mentioned by most studies include sneezing, rhinocnesmus, nasal obstruction, rhinorrhea, facial pain, and dysosmia. In this study, complications of UACS in children varied among different age groups. Different complications were closely related to different pathogeneses in different age groups. These findings suggest that children and parents of different age groups should pay close attention to their own symptoms. Nursing children and pre-school children lack the ability to express themselves. Therefore, the chief complaint always reflects the parents’ attention. Consequently “breathing with the mouth open” ranked first as the main complaint in the study. As children age, their own awareness and skill for expression gradually improve. Therefore, in the school-age children group in the study, “breathing with the mouth open” ranked last, and chief complaints, such as “rhinorrhea,” “ache,” “nasal obstruction,” and “chest tightness,” began to increase. Good communication and attention to feelings of children and their parents can help identify effective clues for diagnosing UACS in children.

A limitation of the study is that it was a small-sample, retrospective study. A randomized, prospective study needs to be performed in the future. Nevertheless, the conclusion of the study has certain clinical value and can guide clinicians, especially pediatricians, in diagnosis and treatment of children with UACS.

doi.org/10.1097/CM9.0000000000000118

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