The Etiology Constituent Ratio And Clinical Features Of 223 Children With Nonspecific Chronic Cough

?Objective?1.To investigate the distribution and etiology constituent ratio in children with nonspecific chronic cough in this area.2.To investigate the main clinical features of common causes of nonspecific chronic cough and their diagnostic value.?Methods?According to the criteria of Guidelines for the Diagnosis and Treatment of Chronic Cough in Chinese Children(Revised in 2013),children with nonspecific chronic cough who visited in the pediatrics of the First Affiliated Hospital of Bengbu Medical College and completed 3-month follow-up from September 2017 to October2019 were included in this study,the collected data were analyzed to clarify the etiology constituent ratio,main clinical features and their diagnostic value of nonspecific chronic cough in children.?Results?1.The general situation: A total of 250 children with chronic cough who met the inclusion criteria were collected in this study,of which 23 children were lost to follow-up,4 children were corrected for specific chronic cough during follow-up,and 223 children with nonspecific chronic cough were actually included in the study.Among the cases actually included,131(58.7%)were males and 92(41.3%)were females;age ranged from 7 months to 14 years,of which 50(22.4%)were ?3 years old,95(42.6%)were 3~6 years old,and 78(35.0%)were ?6 years old.2.The overall situation of the etiology distribution: the etiology distribution from high to low was 64 cases(28.7%)of upper airway cough syndrome(UACS),55 cases(24.7%)of cough variant asthma(CVA),39 cases(17.5%)of UACS combined with CVA,36 cases(16.1%)of post-infection cough(PIC),17 cases(7.6%)of allergic cough(AC),3 cases(1.3%)of UACS combined with PIC,2 cases(0.9%)of gastroesophageal reflux cough(GERC),1 case(0.4%)of CVA combined with PIC,1 case(0.4%)of psychogenic cough,and 5 cases(2.2%)of unknown etiology.3.The etiology distribution at different ages: The top 3 constituent ratio of causes in ?3 years old were PIC(38.0%),UACS(22.0%),CVA(18.0%);the top 3constituent ratio of causes in 3~6 years old were UACS(3 42.1%),CVA(17.9%),UACS combined with CVA(15.8%);the top 3 constituent ratio of causes in ?6 years old were CVA(37.2%),UACS combined with CVA(23.1%),UACS(16.7%).4.The etiology distribution at different genders: The top 3 constituent ratio of causes in male were UACS(36.6%),CVA(23.7%),UACS combined with CVA(19.8%);the top 3 constituent ratio of causes in females were CVA(26.1%),PIC(22.8%),UACS(17.4%).5.The main clinical features and diagnostic value of common single etiology:the main clinical features of UACS in children were wet cough(45 cases),morning cough(47 cases),positive signs of pharynx(posterior pharyngeal wall secretion attachment,obvious proliferation of lymphoid follicles with cobblestone-like changes,etc.)(48 cases).The sensitivity,specificity,positive predictive value and negative predictive value of diagnosing UACS according to wet cough respectively were 70.3%,78.7%,66.2% and 81.7%;the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing UACS according to morning cough respectively were 73.4%,72.2%,61.0% and 82.1%;the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing UACS according to pharyngeal positive signs respectively were 75.0%,87.0%,77.4% and85.5%.The main clinical characteristics of children with CVA are dry cough(49cases),night cough(38 cases),atopic constitution(40 cases),exercise-related cough(39 cases).The sensitivity,specificity,positive predictive value and negative predictive value of diagnosing CVA according to dry cough respectively were98.1%,53.0%,47.1% and 91.2%;the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing CVA according to night cough respectively were 69.1%,79.5%,61.3% and 84.5%;the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing CVA according to atopic constitution respectively were 72.7%,70.9%,54.1% and 84.7%;the sensitivity,specificity,positive predictive value and negative predictive value of diagnosing CVA according to exercise-related cough respectively were 70.9%,58.1%,44.3% and 81.0%.The main clinical characteristics of PIC were related to the history of infection(35 cases),with a sensitivity of 97.2%,specificity of 80.1%,positive predictive value of 56.4%,and negative predictive value of 99.1%.?Conclusions?The top 4 constituent ratio of causes of nonspecific chronic cough in children in this area are UACS,CVA,UACS combined with CVA,PIC.The main causes of nonspecific chronic cough in children of different age groups and gender groups are different.Diagnostic treatment based on the main clinical features is helpful for the etiological diagnosis of non-specific chronic cough.In the absence of clear diagnostic clues,the diagnostic treatment of non-specific chronic cough in this area can be carried out in the order of UACS,CVA and so on.