Anne B Chang1, Peter P Van Asperen2, Nicholas Glasgow3, Colin F Robertson4, Craig M Mellis5, I Brent Masters6, Louis I Landau7, Laurel Teoh8, Irene Tjhung9, Helen L Petsky6, Peter S Morris10. 1. Child Health Division, Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD. Electronic address: annechang@ausdoctors.net. 2. Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW. 3. Medical School, Australian National University, Canberra, ACT. 4. Department of Respiratory Medicine, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC. 5. Sydney Medical School, Central Clinical School, University of Sydney, Sydney, NSW. 6. Queensland Children's Respiratory Centre, Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, QLD. 7. Medical Workforce, Health Department of Western Australia and The University of Western Australia, Perth, WA. 8. Child Health Division, The Canberra Hospital, Canberra, ACT. 9. Child Health Division, Thursday Island Primary Health Care Centre, Thursday Island, QLD, Australia. 10. Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT.
Abstract
BACKGROUND: Chronic cough is associated with poor quality of life and may signify a serious underlying disease. Differentiating nonspecific cough (when watchful waiting can be safely undertaken) from specific cough (treatment and further investigations are beneficial) would be clinically useful. In 326 children, we aimed to (1) determine how well cough pointers (used in guidelines) differentiate specific from nonspecific cough and (2) describe the clinical profile of children whose cough resolved without medications (spontaneous resolution). METHODS: A dataset from a multicenter study involving children newly referred for chronic cough (median duration, 3-4 months) was used to determine the sensitivity, specificity, predictive values, and likelihood ratios (LRs) of cough pointers (symptoms, signs, and simple investigations [chest radiography, spirometry]) recommended in guidelines. RESULTS: The pretest probability of specific cough was 88%. The absence of false-positive results meant that most pointers had strongly positive LRs. The most sensitive pointer (wet cough) had a positive LR of 26.2 (95% CI, 3.8-181.5). Although the absence of other individual pointers did not change the pretest probability much (negative LR close to 1), the absence of all pointers had a strongly negative LR of 0 (95% CI, 0-0.03). Children in the resolved spontaneously group were significantly more likely to be older, to be non-Indigenous, and to have a dry cough and a normal chest radiograph. CONCLUSIONS: Children with chronic dry cough without any cough pointers can be safely managed using the watchful waiting approach. The high pretest probability and high positive LRs of cough pointers support the use of individual cough pointers to identify high risk of specific cough in pediatric chronic cough guidelines. TRIAL REGISTRY: Australian New Zealand Clinical Trials Registry; No.: 12607000526471; URL: www.anzctr.org.au.
BACKGROUND:Chronic cough is associated with poor quality of life and may signify a serious underlying disease. Differentiating nonspecific cough (when watchful waiting can be safely undertaken) from specific cough (treatment and further investigations are beneficial) would be clinically useful. In 326 children, we aimed to (1) determine how well cough pointers (used in guidelines) differentiate specific from nonspecific cough and (2) describe the clinical profile of children whose cough resolved without medications (spontaneous resolution). METHODS: A dataset from a multicenter study involving children newly referred for chronic cough (median duration, 3-4 months) was used to determine the sensitivity, specificity, predictive values, and likelihood ratios (LRs) of cough pointers (symptoms, signs, and simple investigations [chest radiography, spirometry]) recommended in guidelines. RESULTS: The pretest probability of specific cough was 88%. The absence of false-positive results meant that most pointers had strongly positive LRs. The most sensitive pointer (wet cough) had a positive LR of 26.2 (95% CI, 3.8-181.5). Although the absence of other individual pointers did not change the pretest probability much (negative LR close to 1), the absence of all pointers had a strongly negative LR of 0 (95% CI, 0-0.03). Children in the resolved spontaneously group were significantly more likely to be older, to be non-Indigenous, and to have a dry cough and a normal chest radiograph. CONCLUSIONS:Children with chronic dry cough without any cough pointers can be safely managed using the watchful waiting approach. The high pretest probability and high positive LRs of cough pointers support the use of individual cough pointers to identify high risk of specific cough in pediatric chronic cough guidelines. TRIAL REGISTRY: Australian New Zealand Clinical Trials Registry; No.: 12607000526471; URL: www.anzctr.org.au.
Authors: Kian Fan Chung; Lorcan McGarvey; Woo-Jung Song; Anne B Chang; Kefang Lai; Brendan J Canning; Surinder S Birring; Jaclyn A Smith; Stuart B Mazzone Journal: Nat Rev Dis Primers Date: 2022-06-30 Impact factor: 65.038
Authors: Ahmad Kantar; Anne B Chang; Mike D Shields; Julie M Marchant; Keith Grimwood; Jonathan Grigg; Kostas N Priftis; Renato Cutrera; Fabio Midulla; Paul L P Brand; Mark L Everard Journal: Eur Respir J Date: 2017-08-24 Impact factor: 16.671
Authors: Anne B Chang; Siew Moy Fong; Tsin Wen Yeo; Robert S Ware; Gabrielle B McCallum; Anna M Nathan; Mong H Ooi; Jessie de Bruyne; Catherine A Byrnes; Bilawara Lee; Nachal Nachiappan; Noorazlina Saari; Paul Torzillo; Heidi Smith-Vaughan; Peter S Morris; John W Upham; Keith Grimwood Journal: BMJ Open Date: 2019-04-24 Impact factor: 2.692