Cough with wheezing

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Understanding Cough with Wheezing: Insights from Recent Research

Cough Variant Asthma and Wheezing Thresholds

Cough variant asthma (CVA) is a condition where patients primarily exhibit a chronic cough without the classic wheezing associated with asthma. However, a significant number of CVA patients eventually develop wheezing. Research indicates that this transition is linked to an increase in airway hyperresponsiveness rather than a decrease in the wheezing threshold. A study following children with CVA over four years found that those who developed wheezing showed a significant decrease in methacholine PD20 values, indicating increased airway sensitivity, while their wheezing thresholds remained unchanged.

Rhinitis and Its Association with Cough and Wheezing

Rhinitis, an inflammation of the nasal mucous membrane, has been identified as an independent risk factor for both recurrent cough and wheezing in children. A longitudinal study demonstrated that children with rhinitis had a higher likelihood of experiencing recurrent cough and wheezing, even after adjusting for other factors such as sex, skin test reactivity, and parental asthma. This suggests that rhinitis may contribute to respiratory symptoms through mechanisms distinct from those of asthma.

Differentiating Asthma from Other Causes of Cough and Wheezing

Not all cases of cough and wheezing are due to asthma. Conditions such as pertussis, cystic fibrosis, and vocal cord dysfunction can mimic asthma symptoms. Misdiagnosis can lead to inappropriate treatments. Accurate diagnosis requires careful history-taking, spirometry, and sometimes exercise testing to distinguish between asthma and other conditions presenting with similar symptoms.

Nocturnal Cough and Wheezing in Acute Bronchitis

In children with acute bronchitis, cough and wheezing are predominant symptoms that can significantly impact quality of life. Objective monitoring of nocturnal cough and wheezing has shown that these symptoms tend to decrease over time. This monitoring can help evaluate the effectiveness of treatments and provide a clearer picture of the disease's progression.

Impact of Respiratory Symptoms on School Absenteeism

Respiratory symptoms such as cough and wheeze are associated with significant school absenteeism. A study found that children who reported both cough and wheeze were more likely to miss school compared to those with only one of the symptoms. This highlights the importance of managing these symptoms effectively to reduce their impact on children's education.

Phenotypes of Childhood Wheeze and Cough

Research has identified distinct phenotypes of childhood wheeze and cough, suggesting that these symptoms can arise from different underlying mechanisms. For instance, atopic persistent wheeze and transient viral wheeze represent two distinct phenotypes with different prognoses and clinical features. Recognizing these phenotypes can aid in tailoring more effective treatment strategies.

Recurrent Cough and Its Relation to Asthma

Recurrent cough in children, especially when not accompanied by wheeze, may not always indicate asthma. Studies have shown that children with recurrent cough without wheeze do not exhibit the same markers of atopy or airway hyperresponsiveness as those with both symptoms. This suggests that recurrent cough alone may have different underlying causes and should be evaluated separately from classic asthma.

Conclusion

Cough with wheezing in children can arise from various conditions, not just asthma. Understanding the underlying mechanisms, such as increased airway hyperresponsiveness in CVA or the role of rhinitis, is crucial for accurate diagnosis and effective management. Differentiating between asthma and other causes of similar symptoms through careful evaluation can prevent misdiagnosis and ensure appropriate treatment. Additionally, recognizing the impact of these symptoms on quality of life and school attendance underscores the importance of effective symptom management.