title: The duration of acute cough in pre-school children presenting to primary care: a prospective cohort study.
abstract: BACKGROUND
  Professional and parental uncertainty about the natural history of cough in pre-school children may in part be responsible for the high consultation and reconsultation rates and widespread antibiotic use in primary care. A recent systematic review of the natural history of cough included studies of unrepresentative, selected patients with heterogeneous measures and definitions of cough duration.
  
  
  OBJECTIVE
  The aim of the present study was to describe the post-consultation duration of cough, compare this with clinician and parental prediction of cough duration, and to determine the clinical factors associated with prolonged cough.
  
  
  METHODS
  A prospective cohort study of children aged 0-4 years with cough < or =28 days without asthma presenting to eight general practices in Leicestershire, UK was carried out. Socio-demographic and clinical data were collected, and parents and clinicians were asked to predict the proportion recovering within 7, 14, 21 and 28 days. Parents used a symptom diary to record cough and five other symptoms. Survival analysis was used to describe cough duration, and multivariable Cox regression was used to identify the factors independently associated with prolonged cough.
  
  
  RESULTS
  Fifty percent of the children had recovered at 10 days and 90% at 25 days. Cough was associated with fever, breathlessness, disrupted sleep and reduced activity in a high proportion of children. Longer post-consultation cough was associated with longer pre-consultation cough and use of day care facilities. Clinicians overestimated how quickly children recovered from acute cough. Parents' predictions were accurate within 2 weeks, but they underestimated the proportion recovering in weeks 3 and 4.
  
  
  CONCLUSIONS
  Clinicians should be aware that from the parental perspective, acute cough is not a trivial illness and that some children remain unwell at 3-4 weeks. For health professionals negotiating the use of antibiotics, this information may enable parental self-care, reduce medicalization and displace the need to prescribe.
authors.affiliation: Division of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK. alastair.hay@bristol.ac.uk
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
mesh_terms: D002675:Child, Preschool; D003371:Cough / Q000145:classification* / Q000503:physiopathology; D003625:Data Collection; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D013997:Time Factors