Wheezy cough
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Summary
10 papers analyzed
These studies suggest that wheezy cough in children can be associated with different phenotypes, environmental exposures, and underlying conditions like asthma, while in middle age, it is a complex issue requiring targeted treatments.
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Understanding Wheezy Cough: Phenotypes, Prognosis, and Environmental Factors
Phenotypes of Wheezy Cough in Children
Atopic Persistent Wheeze and Transient Viral Wheeze
Research has identified distinct phenotypes of wheezy cough in children, primarily atopic persistent wheeze and transient viral wheeze. Atopic persistent wheeze is characterized by chronic cough, atopy, reduced lung function, and a poor prognosis. In contrast, transient viral wheeze is associated with early-onset wheeze triggered by viral infections and generally has a favorable prognosis.
Variability in Phenotypes
The phenotypes of wheezy cough can vary significantly based on the age at which symptoms are assessed. This variability underscores the importance of considering the timing of symptom evaluation when defining phenotypes.
Natural History and Prognosis
Preschool to School Age Transition
The natural history of wheezy cough shows that fewer than half of preschool children with wheeze continue to wheeze into their early school years. Those with persistent wheeze often exhibit poor ventilatory function, high bronchial responsiveness, and a high prevalence of atopy, which are consistent with asthma.
Long-term Outcomes
Long-term studies indicate that children with a history of asthma or wheezy bronchitis are more likely to experience wheeze and produce phlegm in adulthood. These individuals also tend to have lower FEV1 values and greater bronchial reactivity compared to those without such a history. Additionally, childhood chest illnesses like pneumonia and asthma are linked to chronic cough and phlegm in young adults, particularly if these conditions persist into adolescence.
Environmental and Genetic Factors
Indoor Allergens and Air Contaminants
Exposure to indoor allergens and air contaminants plays a significant role in the development of wheezy cough. For instance, exposure to cockroach allergens and mold increases the risk of wheeze and persistent cough, especially in infants with a maternal history of asthma. Similarly, exposure to gas and wood-burning stoves, as well as nitrogen dioxide, is associated with persistent cough in infants.
Night Cough and Environmental Conditions
Night cough is more common in children with current wheeze and is influenced by environmental factors such as lower overnight air temperature. However, objective tests of asthma severity are not reliable predictors of night cough, indicating the need for further study of the sleeping environment.
Eosinophilic Airway Inflammation
Eosinophilic Bronchitis
Eosinophilic bronchitis, characterized by increased sputum eosinophils, is more prevalent in children with wheeze compared to those with persistent cough or recurrent chest colds. This condition is a good indicator of eosinophilic airway inflammation, which is not typically associated with airway hyperresponsiveness in children with cough or chest colds.
Conclusion
Wheezy cough in children is a complex condition with distinct phenotypes, influenced by genetic, environmental, and age-related factors. Understanding these phenotypes and their natural history is crucial for effective management and prognosis. Environmental exposures, particularly indoor allergens and air contaminants, play a significant role in the development and persistence of wheezy cough. Further research is needed to explore the impact of environmental conditions on night cough and to refine the understanding of eosinophilic airway inflammation in different respiratory conditions.
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