title: Pediatric patients with chronic cough and recurrent croup: the case for a multidisciplinary approach.
abstract: OBJECTIVE
  To evaluate the results of our multidisciplinary approach to recurrent croup and chronic cough.
  
  
  METHODS
  Retrospective chart review of all patients with recurrent croup and chronic cough managed at a tertiary care children's hospital by our Comprehensive Airway, Respiratory, and Esophageal (CARE) Team. Charts were reviewed for all patients who carried a diagnosis of recurrent croup or chronic cough. Patients were excluded if they did not receive a full workup, including micro-direct laryngoscopy, flexible and/or rigid bronchoscopy, bronchioalveolar lavage (BAL), and upper endoscopy with biopsies. We reviewed the records for the presence of gastrointestinal complaints, abdominal pain and failure to thrive (FTT) and compared the children with documented esophagitis to the remaining children.
  
  
  RESULTS
  Forty patients met inclusion criteria. 53% had airway abnormalities; the most common was tracheomalacia, followed by enlarged adenoids. 38% had esophagitis (group 1) while 62% had normal esophageal biopsies (group 2). Among the children in group 1, 27% met criteria for eosinophilic esophagitis (>15 eosinophils per high powered field). There was no significant difference between groups 1 and 2 based on the presence of gastrointestinal complaints, abdominal pain and/or FTT (p>0.05). There was no significant difference between the groups based on the location or presence of an airway abnormality (p>0.05).
  
  
  CONCLUSIONS
  Children with recurrent croup and chronic cough may benefit from a multidisciplinary approach to management. Our CARE Team approach led to a specific diagnosis in almost 95% of patients.
authors.affiliation: Hofstra North Shore LIJ School of Medicine, United States; Division of Gastroenterology and Nutrition, The Steven and Alexandra Cohen Children's Medical Center of New York, United States.
authors.forename: Melanie
authors.initials: M
authors.lastname: Greifer
authors.affiliation: Hofstra North Shore LIJ School of Medicine, United States; Division of Pulmonology, The Steven and Alexandra Cohen Children's Medical Center of New York, United States.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Santiago
authors.affiliation: Hofstra North Shore LIJ School of Medicine, United States; Division of Pulmonology, The Steven and Alexandra Cohen Children's Medical Center of New York, United States.
authors.forename: Kalliope
authors.initials: K
authors.lastname: Tsirilakis
authors.affiliation: Hofstra North Shore LIJ School of Medicine, United States; Division of Pediatric Otolaryngology, The Steven and Alexandra Cohen Children's Medical Center of New York, United States.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Cheng
authors.affiliation: Hofstra North Shore LIJ School of Medicine, United States; Division of Pediatric Otolaryngology, The Steven and Alexandra Cohen Children's Medical Center of New York, United States. Electronic address: LSmith8@nshs.edu.
authors.forename: Lee P
authors.initials: LP
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D003440:Croup / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D004724:Endoscopy; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055090:Tracheomalacia / Q000150:complications / Q000175:diagnosis
keywords: Aerodigestive; Airway; Cough; Croup; Recurrent; Subglottic