Evaluation of patients presenting to the Pediatric Infection Clinic with prolonged cough: A retrospective study

Cough constitutes a significant portion of hospital admissions. It creates psychological damage for families and patients, while leading to increased workload for healthcare workers. With global spending on cough treatment exceeding 10 billion dollars annually, it has become one of the most important health problems due to its tendency to cause excessive tests and treatments. Cough can stem from simple underlying causes or herald serious diseases that, if not diagnosed early, may result in irreversible consequences. In our study, medical records of patients aged between 1 month and 18 years who presented to the Pediatric Infection Outpatient Clinic at Ankara Yenimahalle Education and Research Hospital between November 2016 and March 2020 were reviewed. Data of patients presenting with cough lasting more than two weeks were collected retrospectively from the hospital information system. The clinic, diagnostic stages, diagnoses received, and follow-up periods of the patients were examined. A total of 333 patients were included in the study. The most commonly observed diagnoses in the study were upper respiratory tract infection, pneumonia, sinusitis, laryngitis, and bronchiolitis. Patients were categorized into those with chronic cough (>4 weeks) comprising 216 patients (64.9%) and those with subacute (<4 weeks) cough comprising 117 patients (35.1%). These patients were compared based on various factors such as gender, prematurity, history of previous lower respiratory tract infection, history of atopy, adenoid vegetation history, reflux, known diseases, attendance to daycare or school, having a sibling attending school, characteristics of cough, presence of fever, diurnal variation, findings on chest X-ray, final diagnoses, laboratory findings, treatments received, hospitalization, recovery, and time to recovery. No significant differences were found between patients in the chronic or subacute groups. 69 In this study, 73% (n: 244) of patients underwent chest X-ray, and 54% (n: 132) of these patients had pathological findings (infiltration, atelectasis, effusion, lobar pneumonia). Nasal irrigation with saline solution was recommended to all patients attending the outpatient clinic. Considering particularly in vitro studies conducted on this subject, especially post-COVID-19 infection, it is thought that this treatment modality could offer a cheap, safe, and acceptable alternative, and it sheds light on the potential of breaking the virulence of viral infections with this treatment modality in the future. However, it is a fact that more, high-quality, and sufficiently strong research is needed in this field. 68% (n: 229) of patients had received antibiotic treatment before their referral to our outpatient clinic. After referral, 40 patients needed hospitalization or outpatient antibiotic treatment. Given the high rate of antibiotic use, especially considering that the majority of patients had diagnoses of upper respiratory tract infection and pneumonia, and knowing that more than half of these diseases are viral infections according to the literature, it is noteworthy that only 40 patients truly needed antibiotic treatment, indirectly emphasizing the importance of rational antibiotic use in our study. In the study, the complaint of cough recurred once in 22 patients, twice in 5 patients, three times in 6 patients, and four times in only 1 patient. The mean follow-up period of the patients was 83 days, with a median (IQR) of 20 days. None of the patients in our study were recommended antitussive, expectorant, or herbal products. When laboratory findings were examined, no significant difference was found between those with persistent cough and those without in terms of findings. Similar to the literature, the significant benefit of investigating the etiology of persistent cough with acute phase reactants was not found. In conclusion, persistent cough is often caused by self-limiting infections that typically do not require antibiotics, and can be resolved by nasal irrigation with saline solution. Keywords:Pediatrics, chronic cough, nasal irrigation, subacute cough, upper airway syndrome, pneumonia