Outcomes in children referred for chronic cough

• Research type

  Research Study

• Full title

  Outcomes in children referred for chronic cough and clinical markers for presence of bronchiectasis

• IRAS ID

  240789

• Contact name

  Manjith Narayanan

• Contact email

  mn87@le.ac.uk

• Sponsor organisation

  University Hospitals Leicester NHS Trust

• Duration of Study in the UK

  0 years, 7 months, 27 days

• Research summary

  Summary of Research

  Title: Outcomes in children referred for chronic cough and clinical markers for presence of bronchiectasis
  Short Title: Outcomes in children referred for chronic cough

  Background: Chronic cough is one of the most frequent reasons for referral of children from general practitioners to secondary care. This symptom could be benign or indicate serious underlying disease like bronchiectasis (a condition where the airways of the lungs become abnormally widened). With the currently available literature in the field, it is not possible to determine key findings which are associated with serious underlying disease in this age group. The aim of this study is to determine the key symptoms and physiological parameters that indicate the presence of a serious underlying condition such as bronchiectasis.
  
  Methods: All referrals for chronic cough (>8 weeks) in children of Leicestershire are screened at an existing paediatric respiratory referral Multi-disciplinary Team meeting. All these children are assessed in a paediatric respiratory clinic and diagnostic tests are carried out as per existing guidelines, which may include spirometry. A high resolution computed tomography (HRCT) scan is done in a clinically appropriate subset of patients, in order to diagnose the presence of bronchiectasis. In addition to the standard diagnostic tests, we are proposing that study participants aged 5 years and over have 3 additional tests: two tests of exercise tolerance and a test of airway homogeneity called a multi-breath nitrogen washout. The tests of exercise tolerance are a 6 minute walk test and a three minute step test.

  Analysis: Information from the clinical findings, laboratory findings and functional assessments will be collated prospectively. Clinical and functional risk factors for the presence of bronchiectasis or other serious lung disease will be analysed by statistical methods. Depending on the statistical significance of the results, the results may inform future management guidelines or guide a further study.

  Chronic cough is a common problem in children. This study aimed at following up children who had been referred to hospital for prolonged cough. We wanted to identify any factors that might predispose to severe disease and/or impact growth.
  We collected information using questionnaires, clinical notes and results of hospital tests on 41 children. Some children also had extra tests including breathing tests, exercise tests and activity monitoring. Due to the COVID pandemic, we were not able to study as many children as we had intended.

  We found that children where the nature of cough was described as ‘wet’ cough were more likely to have a more severe underlying disease. On the other hand, wheeze or cough which improved on reliever (blue) inhaler were likely to have asthma or pre-school wheeze. Children with severe and prolonged ‘wet’ cough tended to grow slightly less well in height. However, it is not known whether they catch up later.

  Very few researchers have attempted to use activity monitoring in young children. We found that this is acceptable in children as young as 2 years of age.

  Future findings have the potential to influence the way in which children with chronic cough are managed. We are pleased that chronic cough is receiving the recognition it deserves.

• REC name

  London - Hampstead Research Ethics Committee

• REC reference

  18/LO/2113

• Date of REC Opinion

  5 Dec 2018

• REC opinion

  Favourable Opinion