title: A multicenter study on chronic cough in children : burden and etiologies based on a standardized management pathway.
abstract: BACKGROUND
  While the burden of chronic cough in children has been documented, etiologic factors across multiple settings and age have not been described. In children with chronic cough, we aimed (1) to evaluate the burden and etiologies using a standard management pathway in various settings, and (2) to determine the influence of age and setting on disease burden and etiologies and etiology on disease burden. We hypothesized that the etiology, but not the burden, of chronic cough in children is dependent on the clinical setting and age.
  
  
  METHODS
  From five major hospitals and three rural-remote clinics, 346 children (mean age 4.5 years) newly referred with chronic cough (> 4 weeks) were prospectively managed in accordance with an evidence-based cough algorithm. We used a priori definitions, timeframes, and validated outcome measures (parent-proxy cough-specific quality of life [PC-QOL], a generic QOL [pediatric quality of life (PedsQL)], and cough diary).
  
  
  RESULTS
  The burden of chronic cough (PC-QOL, cough duration) significantly differed between settings (P = .014, 0.021, respectively), but was not influenced by age or etiology. PC-QOL and PedsQL did not correlate with age. The frequency of etiologies was significantly different in dissimilar settings (P = .0001); 17.6% of children had a serious underlying diagnosis (bronchiectasis, aspiration, cystic fibrosis). Except for protracted bacterial bronchitis, the frequency of other common diagnoses (asthma, bronchiectasis, resolved without specific-diagnosis) was similar across age categories.
  
  
  CONCLUSIONS
  The high burden of cough is independent of children’s age and etiology but dependent on clinical setting. Irrespective of setting and age, children with chronic cough should be carefully evaluated and child-specific evidence-based algorithms used.
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD. Electronic address: annechang@ausdoctors.net.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: Department of Respiratory Medicine, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC.
authors.forename: Colin F
authors.initials: CF
authors.lastname: Robertson
authors.affiliation: Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney Children's Hospitals Network, University of Sydney, Sydney, NSW.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Van Asperen
authors.affiliation: Medical School, Australian National University, Canberra, ACT.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Glasgow
authors.affiliation: Central Clinical School, University of Sydney, Sydney, NSW.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Mellis
authors.affiliation: Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD.
authors.forename: I Brent
authors.initials: IB
authors.lastname: Masters
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; The Canberra Hospital, Canberra, ACT.
authors.forename: Laurel
authors.initials: L
authors.lastname: Teoh
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; Thursday Island Primary Health Care, Thursday Island, QLD.
authors.forename: Irene
authors.initials: I
authors.lastname: Tjhung
authors.affiliation: Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT; NT Clinical School, Flinders University, Darwin, NT.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.affiliation: Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Petsky
authors.affiliation: Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD.
authors.forename: Carol
authors.initials: C
authors.lastname: Willis
authors.affiliation: Postgraduate Medical Council of Western Australia, Health Department of Western Australia, Perth, WA, Australia.
authors.forename: Lou I
authors.initials: LI
authors.lastname: Landau
mesh_terms: D000465:Algorithms; D001249:Asthma / Q000150:complications*; D001987:Bronchiectasis / Q000150:complications*; D001991:Bronchitis / Q000150:complications*; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires