The General conditions: The 420 study subjects included 235 male (55.9%) and 185 female (44.1%) patients, with an average age of 5.67 ± 2.59 years.
3.1. The etiological composition and cough character
Table 1 showed etiological composition and cough character of chronic cough. The number of children between 1 years and 3 years was 48 (11.4%), the number of children between 3 years and 6 years was 227 (54.0%), and the number of children between 6 years and 14 years old was 145 (34.5%).
Table 1
Comparison of etiological composition and cough character of chronic cough in Children
Item | n | PIC | CVA | UACS | AC | TS | GERD | X2 | p |
Age | 1 ~ 3 | 48 | 17(35.4) | 8(16.7) | 12(25.0) | 9(18.7) | 1(2.1) | 1(2.1) | 11.242 | 0.339 |
~ 6 | 227 | 86(37.9) | 43(18.9) | 48(21.1) | 45(19.8) | 5(2.2) | 0(0.0) |
~ 14 | 145 | 43(29.7) | 39(26.9) | 36(24.8) | 21(14.5) | 5(3.4) | 1(0.7) |
Cough character | Dry | 144 | 36(25.0) | 41(28.5) | 24(16.7) | 34(23.6) | 8(5.6) | 1(0.7) | 25.948 | < 0.001 |
Wet | 276 | 110(39.9) | 49(17.8) | 72(26.1) | 41(14.9) | 3(1.1) | 1(0.4) |
Total | -- | 420 | 146(34.8) | 90(21.4) | 96(22.9) | 75(17.9) | 11(2.6) | 2(0.5) | -- | -- |
Etiological composition of chronic cough: PIC is the most common (34.8%) cause of chronic cough in children of 1–14 years old, followed by UACS (22.9%), CVA (21.4%), AC (17.9%), TS (2.6%) and GERD (0.5%). Among these, in the young children (1–3 years old), the sequence of the common cause of chronic cough was PIC (35.4%), UACS (25.0%), CVA (16.7%), AC (18.7%), GERC (2.1%) and TS (2.1%). In the preschool children (3–6 years old), the sequence of the common cause of nonspecific chronic cough was PIC (37.9%), UACS (21.1%), AC (19.8%), CVA (18.9%), TS (2.2%) and GERD (0.0%). In the school-age children (6–14 years old), the sequence of the common cause of nonspecific chronic cough was PIC (29.7%), CVA (26.9%), UACS (34.8%), AC (14.5%), TS (3.4%) and GERD (0.7%). There was no significant difference in etiological components among different ages (P > 0.05).
In respect of cough character, 144 children (34.3%) were dry cough, and 276 children (65.7%) were wet cough. The common causes of wet cough were PIC (39.9%), UACS (26.1%), CVA (17.8%), AC (14.9%), TS (1.1%) and GERD (0.4%).The common causes of dry cough were CVA (28.5%), PIC (25.0%), AC (23.6%), UACS (16.7%), TS (5.6%) and GERD (0.7%).There was a significant difference in the cause of dry cough and wet cough (P༜0.001) .
3.2. The attack time and associated symptoms
Table 2 showed attack time and associated symptoms of chronic cough. The clinical manifestations of the patients in the PIC group included nasal congestion and runny nose. The patients in the CVA group presented with cough at night,in the morning, after exercise as the most characteristic feature. The clinical signs of the patients in the UACS group included cough in the morning, at night, nasal congestion, runny nose and sneezing. The patients in the AC group typically exhibited cough in the morning, in the evening and itchy throat. The characteristics of TS cough group were cough in daytime and disappear after sleep, accompanied by throat itching and throat clearing. The patients in the GERD group showed typical acid regurgitation.
Table 2
The attack time and associated symptoms of children with nonspecific chronic cough
Item | PIC | CVA | UACS | AC | TS | GERD |
n | 146 | 90 | 96 | 75 | 11 | 2 |
Attack time | morning | 91(62.3) | 59(65.5) | 62(64.6) | 40(53.3) | 6(54.5) | 1(50.0) |
| afternoon | 42(28.8) | 3(3.3) | 9(9.4) | 13(17.3) | 6(54.5) | 0(0) |
| evening | 55(37.7) | 1(1.1) | 45(46.9) | 38(50.7) | 7(63.6) | 1(50.0) |
| night | 76(52.1) | 73(81.1) | 6(6.3) | 11(14.7) | 0(0) | 1(50.0) |
| After exercise | 31(21.2) | 39(43.3) | 13(13.5) | 33(44.0) | 3(27.2) | 1(50.0) |
Associated Symptoms | nasal congestion | 87(59.6) | 16(17.8) | 73(76.0) | 13(17.3) | 0(0.0) | 0(0.0) |
| runny nose | 75(51.4) | 0(0.0) | 61(63.5) | 6(8.0) | 0(0.0) | 0(0.0) |
| sneezing | 57(39.0) | 12(13.3) | 63(65.6) | 24(32.0) | 2(18.1) | 0(0.0) |
| itchy throat | 57(39.0) | 18(20.0) | 28(29.2) | 67(89.3) | 7(63.6) | 1(50.0) |
| feeling of mucus attachment | 29(19.9) | 3(3.3) | 45(46.8) | 27(36.0) | 0(0.0) | 0(0.0) |
| Snoring | 20(13.7) | 19(21.1) | 21(21.9) | 12(16) | 4(36.3) | 0(0.0) |
| sour regurgitation | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) | 2(100.0) |
| sigh | 2(1.4) | 0(0.0) | 0(0.0) | 1(1.3) | 2(18.1) | 0(0.0) |
| molar | 2(1.4) | 0(0.0) | 0(0.0) | 0(0.0) | 3(27.3) | 0(0.0) |
3.3. The medication history
Table 3 showed the medication history of children with chronic cough. 281 children (67.1%)had a history of using Antimicrobial, 158 children (37.6%) had a history of using cough medication, 191 children (45.5%) had a history of using antihistamine, 136 children (32.4%) had a history of using Montelukast, 120 children (28.6%) had a history of using atomization inhalation preparation and 60 children (14.3%) had a history of using nasal spray.
Table 3
The medication history of children with nonspecific chronic cough (n = 420)
| Total sample n(%) |
Have medication history | 371(88.3) |
Antimicrobials | had used | 281(67.1) |
| Azitromycin | 175(41.7) |
| Clarithromycin | 13(3.1) |
| Penicillin | 5(1.2) |
| First-generation cephalosporin | 4(1.0) |
| Second-generation cephalosporin | 94(22.4) |
| Third-generation cephalosporin | 56(13.3) |
Cough Medication | have used | 158(37.6) |
| Procaterol | 133(31.7) |
| Apophlegmatisant | 32(7.6) |
Antihistamine | 191(45.5) |
Montelukast | 136(32.4) |
Inhalation preparation | 120(28.6) |
Nasal spray | 60(14.3) |
Chinese patent drug | 185(44.1) |
Chinese herbal medicine | 264(62.9) |
Among Antimicrobials, 175 children (41.7%) had a history of using azithromycin, 13 children (3.1%) had a history of using clarithromycin. 5 children (1.2%) had a history of using penicillin. 154 children (36.7%) had a history of using β-lactam antibiotics.
Among cough medications, 133 children (31.7%) had a history of using Procaterol and 32 children (7.6%) had a history of using apophlegmatisant.
Among atomization inhalation preparation, 120 children (28.5%) had a history of using terbutaline combined with budesonide, 2 children had a history of using Seretide.
185 children (44.1%) had a history of using Chinese patent drug. 264 children (62.9%) had a history of using Chinese herbal medicine.
3.4. The past medical history, allergic history, family medical history and living environment
Table 4 showed the past medical history, allergic history, family medical history and living environment of children with nonspecific chronic cough. 273 children (65.0%) had past medical history, including 133 cases of eczema history (31.7%), 139 cases of rhinitis history (33.1%), 38 cases of adenoid vegetation history (9.0%), 33 cases of pneumonia history (7.8%), 13 cases of anaemia history (3.1%), 5 cases of gastritis history (1.2%) and 3 cases of obesity history (0.7%).
Table 4
The past medical history, allergic history, family medical history and living environment of children with chronic cough (n = 420)
| Total sample n (%) |
Past medical history | eczema | 133(31.7) |
| rhinitis | 139(33.1) |
| adenoid vegetation | 38(9.0) |
| pneumonia | 33(7.8) |
| anaemia | 13(3.1) |
| gastritis | 5(1.2) |
| obesity | 3(0.7) |
Allergic history | dust mites | 21(5.0) |
| egg | 20(4.8) |
| milk | 18(4.3) |
| seafood | 7(1.7) |
| nut | 7(1.7) |
| pollen | 3(0.7) |
| beef/mutton | 3(0.7) |
| animal hairs | 3(0.7) |
| others | 6(1.4) |
Family medical history | rhinitis | 68(16.2) |
| asthma | 16(3.8) |
| passive smoking | 133(31.7) |
| cultivate plants | 134(31.9) |
Living environment | keep pets | 22(5.2) |
| along the street | 105(25.0) |
63 children (15.0%) had allergic history, including 21 dust mites-allergic children (5.0%), 20 egg-allergic children (4.8%), 18 milk-allergic children (4.3%), 7 seafood-allergic children (1.7%), 7 nut-allergic children (1.7%), 3 pollen-allergic children (0.7%), 3 beef/mutton-allergic children (0.7%), 3 animal hairs-allergic children (0.7%) and 6 allergy to other substances (1.4%, 2 mango-allergic children, 1 chocolate-allergic child, 1 chicken-allergic child, 1 mycete-allergic child, 1 Penicillin-allergic child).
84 cases (20.0%) had family medical history, including 68 cases of family rhinitis history (16.2%), 16 cases of family asthma history (3.8%).
133 children’s family (31.7%) had smokers among the surrounding.134 families (31.9%) grew plants. 22 families (5.2%) kept pets.105 children’s (25.0%) home was along the street.