Evaluation of congenital heart diseases in children with chronic cough

Chronic cough in children is described as daily, resistive cough persisting longer than four weeks. In children, cough recovers by itself and there are no objective criteria to assess the severity of cough. These reasons make it very difficult to describe the chronicity of the cough and conduct epidemiological studies. Due to these factors, the number of studies on chronic cough and its etiology are limited, and consequently adult guidelines are generally used in practice. The aim of this study was to investigate the chronic cough etiology and congenital heart disease frequency among patients who were followed up by the Dicle University Faculty of Medicine's Pediatric Pulmonology Department between January 2012 and August 2014. A total of 150 patients who underwent further cardiac consultation based on their history, physical examination and radiological studies were included in the study. In this study, 150 patients followed for chronic cough were retrospectively studied in regard to their etiological workup and congenital heart disease frequency. Each patient's history, physical examination, duration and character of cough, exposure to smoke, lung x-ray, immunoglobulin, thorax computerized tomography, broncoscopy, sweat test, fasting gastric fluid, esophagogastric-duodenum radiographies, respiratory function test, PPD (Purified Protein Derivative) test and echocardiography data were obtained from his or her files. The diagnosis of 150 patients was as follows: 55 with allergic rhinitis (36.7%), 33 with asthma (22%), 30 with cystic fibrosis (20%), 9 with bronchiectasis (6%), 4 with tuberculosis (2.7%), 4 with bronchomalasia (2.7%), 3 with bronchopulmonary dysplasia (2%), 3 with non-specific cough (2%), 2 with immune deficiency (1.2%), 1 with tracheaesophageal fistula (0.7%), 1 with bronchiolitis obliterans (0.7%), 1 with Kartagener syndrome (0.7%), 1 with tracheomalasia (0.7%) and 1 with gastroesophageal reflux (0.7%). Out of 150 patients, 24 (16%) were diagnosed with congenital heart disease. These were distributed as: 13 with ventricular septal defect (8.7%), 7 with atrial septal defect (4.7%), 5 with patent ductus arteriosus (3.3%), 1 with transposition of great arteries (0.7%), 1 with dextrocardia (0.7%), 1 with single ventricle (0.7%), 1 with coarctation of the aorta (0.7%). In 3 patients (2%) ventricular septal defect was accompanied by atrial septal defect, and in 1 patient (0.7%) patent ductus arteriosus was accompanied by single ventricle. It must be emphasized that right to left shunted congenital heart diseases cause pulmonary congestion, which is related to recurrent lung infections and chronic cough. This must be kept in mind while assessing children with chronic cough and these individuals should undergo cardiologic evaluation in the presence of supporting findings. Keywords: Children, chronic cough, etiology, congenital heart disease