Top

Published in:

Open Access 01-12-2021 | Whooping Cough | Research

Coughing children in family practice and primary care: a systematic review of prevalence, aetiology and prognosis

Authors: Milena Bergmann, Jörg Haasenritter, Dominik Beidatsch, Sonja Schwarm, Kaja Hörner, Stefan Bösner, Paula Grevenrath, Laura Schmidt, Annika Viniol, Norbert Donner-Banzhoff, Annette Becker

Published in: BMC Pediatrics | Issue 1/2021

Abstract

Background

For evidence-based decision making, primary care physicians need to have specific and reliable information on the pre-test probabilities of underlying diseases and a symptom’s course. We performed a systematic review of symptom-evaluating studies in primary care, following three research questions: (1) What is the prevalence of the symptom cough in children consulting primary care physicians? (2) What are the underlying aetiologies of cough and the respective frequencies? (3) What is the prognosis of children with cough?

Methods

Following a pre-defined algorithm and independent double reviewer ratings we searched MEDLINE and EMBASE. All quantitative original research articles in English, French or German were included if they focused on unselected study populations of children consulting a primary care physician for cough. We used the random effects model for meta-analysis in subgroups, if justifiable in terms of heterogeneity.

Results

We identified 14 eligible studies on prevalence, five on aetiology and one on prognosis. Prevalence estimates varied between 4.7 and 23.3% of all reasons for an encounter, or up to estimates of 60% when related to patients or consultations. Cough in children is more frequent than in adults, with lowest prevalences in adolescents and in summer. Acute cough is mostly caused by upper respiratory tract infections (62.4%) and bronchitis (33.3%); subacute or chronic cough by recurrent respiratory tract infection (27.7%), asthma (up to 50.4% in cough persisting more than 3 weeks), and pertussis (37.2%). Potentially serious diseases like croup, pneumonia or tuberculosis are scarce. In children with subacute and chronic cough the total duration of cough ranged from 24 to 192 days. About 62.3% of children suffering from prolonged cough are still coughing two months after the beginning of symptoms.

Conclusion

Cough is one of the most frequent reasons for an encounter in primary care. Our findings fit in with current guideline recommendations supporting a thoughtful wait-and-see approach in acute cough and a special awareness in chronic cough of the possibility of asthma and pertussis. Further evidence of aetiological pre-test probabilities is needed to assess the diagnostic gain based on patient history and clinical signs for differential diagnoses of cough in children.

Available only for authorised users

Fegeler U, Jager-Roman E, Martin R, Nentwich H-J. Pediatric primary healthcare: health services study of the German academy for child and adolescent medicine. [German]. Monatsschrift fur Kinderheilkunde. 2014;162(12):1117–30. https://doi.org/10.1007/s00112-014-3258-7.CrossRef

Lamas A, Ruiz de Valbuena M, Máiz L. Cough in Children. Arch Bronconeumol. 2014;50(7):294–300. https://doi.org/10.1016/j.arbres.2013.09.011.CrossRefPubMed

Hsiao C-J, Cherry DK, Beatty PC, Rechtsteiner EA. National Ambulatory Medical Care Survey: 2007 Summary. Nat Health Stat Report 2010:1–32.

Cornford CS, Morgan M, Ridsdale L. Why do mothers consult when their children cough? Fam Pract. 1993;10(2):193–6. https://doi.org/10.1093/fampra/10.2.193.CrossRefPubMed

Ramanuja S, Kelkar PS. The approach to pediatric cough. Ann Allergy Asthma Immunol. 2010;105:3–8; quiz 9–11, 42.

Marchant JM, Newcombe PA, Juniper EF, Sheffield JK, Stathis SL, Chang AB. What is the burden of chronic cough for families? Chest. 2008;134(2):303–9. https://doi.org/10.1378/chest.07-2236.CrossRefPubMed

Shields MD, Bush A, Everard ML, McKenzie S, Primhak R. Recommendations for the assessment and management of cough in children. Thorax. 2008;63(Suppl 3):iii1–iii15.PubMed

Hay AD, Heron J, Ness A. The prevalence of symptoms and consultations in pre-school children in the Avon longitudinal study of parents and children (ALSPAC): a prospective cohort study. Fam Pract. 2005;22(4):367–74. https://doi.org/10.1093/fampra/cmi035.CrossRefPubMed

Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics. Chest. 2006;129(1):260S–83S. https://doi.org/10.1378/chest.129.1_suppl.260S.CrossRefPubMed

10.

Chang AB, Oppenheimer JJ, Weinberger M, Grant CC, Rubin BK, Irwin RS, et al. Etiologies of chronic cough in pediatric cohorts: CHEST guideline and expert panel report. Chest. 2017;152(3):607–17. https://doi.org/10.1016/j.chest.2017.06.006.CrossRefPubMedPubMedCentral

11.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097.CrossRefPubMedPubMedCentral

12.

Donner-Banzhoff N, Kunz R, Rosser W. Studies of symptoms in primary care. Fam Pract. 2001;18(1):33–8. https://doi.org/10.1093/fampra/18.1.33.CrossRefPubMed

13.

Viniol A, Keunecke C, Biroga T, Stadje R, Dornieden K, Bösner S, et al. Studies of the symptom abdominal pain—a systematic review and meta-analysis. Fam Pract. 2014;31(5):517–29. https://doi.org/10.1093/fampra/cmu036.CrossRefPubMed

14.

Stadje R, Dornieden K, Baum E, Becker A, Biroga T, Bösner S, et al. The differential diagnosis of tiredness: a systematic review. BMC Fam Pract. 2016;17(1):147. https://doi.org/10.1186/s12875-016-0545-5.CrossRefPubMedPubMedCentral

15.

Haasenritter J, Biroga T, Keunecke C, Becker A, Donner-Banzhoff N, Dornieden K, et al. Causes of chest pain in primary care—a systematic review and meta-analysis. Croat Med J. 2015;56(5):422–30. https://doi.org/10.3325/cmj.2015.56.422.CrossRefPubMedPubMedCentral

16.

Bösner S, Schwarm S, Grevenrath P, Schmidt L, Hörner K, Beidatsch D, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. BMC Fam Pract. 2018;19(1):33. https://doi.org/10.1186/s12875-017-0695-0.CrossRefPubMedPubMedCentral

17.

Viniol A, Beidatsch D, Frese T, Bergmann M, Grevenrath P, Schmidt L, et al. Studies of the symptom dyspnoea: a systematic review. BMC Fam Pract. 2015;16(1):152. https://doi.org/10.1186/s12875-015-0373-z.CrossRefPubMedPubMedCentral

18.

Richardson WS, Wilson MC, Guyatt GH, Cook DJ, Nishikawa J. Users’ guides to the medical literature: XV. How to use an article about disease probability for differential diagnosis. Evidence-Based Medicine Working Group JAMA 1999;281:1214–1219.

19.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al. Cochrane handbook for systematic reviews of interventions. 2019. Available at: www.training.cochrane.org/handbook. Accessed 24 Jan 2021, https://doi.org/10.1002/9781119536604.

20.

Boyce SP, Nyangara F, Kamunyori J. A mixed-methods quasi-experimental evaluation of a mobile health application and quality of care in the integrated community case management program in Malawi. J Glob Health. 2019;9(1):10811. https://doi.org/10.7189/jogh.09.010811.CrossRef

21.

Cazzato T, Pandolfini C, Campi R, Bonati M. Drug prescribing in out-patient children in southern Italy. Eur J Clin Pharmacol. 2001;57(8):611–6. https://doi.org/10.1007/s002280100356.CrossRefPubMed

22.

Giannattasio A, Lo Vecchio A, Napolitano C, Di Florio L, Guarino A. A prospective study on ambulatory care provided by primary care pediatricians during influenza season. Ital J Pediatr. 2014;40(1):38. https://doi.org/10.1186/1824-7288-40-38.CrossRefPubMedPubMedCentral

23.

Hall KK, Chang AB, Anderson J, Dunbar M, Arnold D, O’Grady K-AF. Characteristics and respiratory risk profile of children aged less than 5 years presenting to an urban, Aboriginal-friendly, comprehensive primary health practice in Australia. J Paediatr Child Health. 2017;53(7):636–43. https://doi.org/10.1111/jpc.13536.CrossRefPubMed

24.

Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, et al. Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006;333(7560):174–7. https://doi.org/10.1136/bmj.38870.655405.AE.CrossRefPubMedPubMedCentral

25.

Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ. Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough. Global Pediatric Health. 2019;6:2333794X19831296.

26.

Leconte S, Degryse J. Prolonged cough in children in the primary care office. Rev Med Brux. 2011;32:5–9.PubMed

27.

Mash B, Fairall L, Adejayan O, Ikpefan O, Kumari J, Matheel S, et al. A morbidity survey of south African primary care. PLoS One. 2012;7(3):e32358. https://doi.org/10.1371/journal.pone.0032358.CrossRefPubMedPubMedCentral

28.

Molony D, Beame C, Behan W, Crowley J, Dennehy T, Quinlan M, et al. 70,489 primary care encounters: retrospective analysis of morbidity at a primary care Centre in Ireland. Ir J Med Sci. 2016;185(4):805–11. https://doi.org/10.1007/s11845-015-1367-5.CrossRefPubMed

29.

Morrell DC, Gage HG, Robinson NA. Symptoms in general practice. J R Coll Gen Pract. 1971;21(102):32–43.PubMedPubMedCentral

30.

Morrell DC. Symptom interpretation in general practice. J R Coll Gen Pract. 1972;22(118):297–309.PubMedPubMedCentral

31.

Movsowitz L. Chronic cough and cough mixtures in a private paediatric practice. S Afr Med J. 1987;71(9):573–4.PubMed

32.

Schappert SM, Nelson C. National Ambulatory Medical Care Survey: 1995-96 summary. Vital Health Stat 13. 1999; series 13, data from the National Health Survey (142):i-vi, 1-122.

33.

Nizami SQ, Khan IA, Bhutta ZA. Paediatric prescribing in Karachi. J Pak Med Assoc. 1997;47(1):29–32.PubMed

34.

Njalsson T, McAuley RG. Reasons for contact in family practice. An Icelandic multicentre study on content of practice. Scand J Prim Health Care. 1992;10(4):250–6. https://doi.org/10.3109/02813439209014070.CrossRefPubMed

35.

Frese T, Klauss S, Herrmann K, Sandholzer H. Children and adolescents as patients in general practice - the reasons for encounter. J Clin Med Res. 2011;3:177–82.PubMedPubMedCentral

36.

Simoes EA, Desta T, Tessema T, Gerbresellassie T, Dagnew M, Gove S. Performance of health workers after training in integrated management of childhood illness in Gondar, Ethiopia. Bull World Health Organ. 1997;75(Suppl 1):43–53.PubMedPubMedCentral

37.

Okkes IM, Oskam SK, Lamberts H. The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. J Fam Pract. 2002;51(1):31–6.PubMed

38.

Usherwood TP. Development and randomized controlled trial of a booklet of advice for parents. Br J Gen Pract. 1991;41(343):58–62.PubMedPubMedCentral

39.

Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Pract. 1993;37(1):23–7.PubMed

40.

Cochrane Deutschland, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften - Institut für Medizinisches Wissensmanagement. Bewertung des Biasrisikos (Risiko systematischer Fehler) in klinischen Studien: ein Manual für die Leitlinienerstellung. [Evaluation of risk of bias (ris of systematic bias) in clinical studies: a manual for guideline development] 2016. http://www.cochrane.de/de/rob-manual; AWMF: http://www.awmf.org/leitlinien/awmf-regelwerk/ll-entwicklung.html. Accessed 24 Jan 2021.

41.

Ptak K, Cichocka-Jarosz E, Kwinta P. Chronic cough in children. Developmental Period Medicine. 2018;22.

42.

Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough. Chest. 2006;129(5):1132–41. https://doi.org/10.1378/chest.129.5.1132.CrossRefPubMed

43.

Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, Mellis CM, Masters IB, et al. A multicenter study on chronic cough in children. Chest. 2012;142(4):943–50. https://doi.org/10.1378/chest.11-2725.CrossRefPubMed

44.

Jurca M, Ramette A, Dogaru CM, Goutaki M, Spycher BD, Latzin P, et al. Prevalence of cough throughout childhood: a cohort study. PLoS One. 2017;12(5):e0177485. https://doi.org/10.1371/journal.pone.0177485.CrossRefPubMedPubMedCentral

45.

Chang AB, Widdicombe JG. Cough throughout life: children, adults and the senile. Pulm Pharmacol Ther. 2007;20(4):371–82. https://doi.org/10.1016/j.pupt.2006.10.004.CrossRefPubMed

46.

Irwin RS, French CL, Chang AB, Altman KW. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest. 2018;153(1):196–209. https://doi.org/10.1016/j.chest.2017.10.016.CrossRefPubMed

47.

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(Suppl 1):1S–23S. https://doi.org/10.1378/chest.129.1_suppl.1S.CrossRefPubMedPubMedCentral

48.

Kohno S, Ishida T, Uchida Y, Yoshyuki KH, Sasaki H, Shioya T, et al. The Japanese respiratory society guidelines for management of cough. Respirology. 2006;11(Suppl 4):S135–86.PubMed

49.

Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, et al. Clinical practice guidelines for diagnosis and Management of Cough-Chinese Thoracic Society (CTS) asthma consortium. J Thorac Dis. 2018;10(11):6314–51. https://doi.org/10.21037/jtd.2018.09.153.CrossRefPubMedPubMedCentral

50.

Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, et al. Cough in children: definitions and clinical evaluation. Med J Aust. 2006;184(8):398–403. https://doi.org/10.5694/j.1326-5377.2006.tb00290.x.CrossRefPubMed

51.

Hay AD, Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review. Br J Gen Pract. 2002;52(478):401–9.PubMedPubMedCentral

52.

Asilsoy S, Bayram E, Agin H, Apa H, Can D, Gulle S, et al. Evaluation of chronic cough in children. Chest. 2008;134(6):1122–8. https://doi.org/10.1378/chest.08-0885.CrossRefPubMed

53.

Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. The Cochrane database of systematic reviews 2018;4.

54.

Hay AD, Wilson A, Fahey T, Peters TJ. The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study. Fam Pract. 2003;20(6):696–705. https://doi.org/10.1093/fampra/cmg613.CrossRefPubMed

55.

Stocks N, Fahey T. Labelling of acute respiratory illness: evidence of between-practitioner variation in the UK. Fam Pract. 2002;19(4):375–7. https://doi.org/10.1093/fampra/19.4.375.CrossRefPubMed

Title: Coughing children in family practice and primary care: a systematic review of prevalence, aetiology and prognosis
Authors: Milena Bergmann
Jörg Haasenritter
Dominik Beidatsch
Sonja Schwarm
Kaja Hörner
Stefan Bösner
Paula Grevenrath
Laura Schmidt
Annika Viniol
Norbert Donner-Banzhoff
Annette Becker
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Whooping Cough
Cough
Bronchial Asthma
Care
Cough
Cough
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02739-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Coughing children in family practice and primary care: a systematic review of prevalence, aetiology and prognosis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Clinical and genetic characteristics of concomitant Mucopolysaccharidosis type IVA and neurogenic bladder in children: two case reports and literature review

Dandy-Walker malformation in methylmalonic acidemia: a rare case report

Major heart defects: the diagnostic evaluations of first-year-olds

Helping babies breathe: assessing the effectiveness of simulation-based high-frequency recurring training in a community-based setting of Pakistan

Concentrations of oligosaccharides in human milk and child growth

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned