Current status of chronic cough treatment in Chinese children

Objective To comprehensively understand the current situation of the treatment of chronic cough in Chinese children and provide evidence for a reasonable standard therapy. Method According to the 2008 Guideline of diagnosis and treatment of chronic cough in children that were formulated by The Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and the Editorial Board of Chinese Journal of Pediatrics, the questionnaire of the cause of chronic cough in children was designed and 29 hospitals in 19 provinces, municipalities and autonomous regions were enrolled. Cases with chronic cough completed 3-month follow-up during May 2009 to April 2010 and information about drug treatment was collected. All data were input through Epidata 3.0 and SPSS19.0 software for statistical analysis. Result Totally 4 529 cases were eligible (the passing rate is 98.8%). The leading three causes were cough variant asthma (CVA), upper airway cough syndrome (UACS) and post-infectious cough (PIC). The drug treatment was given to 3 537 cases (77.2%) at the first visit, and 1 044 cases (22.8%) were not given the treatment but were followed up for observation. In the follow-up period 2 524 cases adhered to medication (55.1%), 2 057 cases (44.9%) failed to adhere to treatment. The leading three medications in CVA patients was leukotriene receptor antagonists (81.68%), antihistamines (50.53%) and beta 2 agonists (37.77%). Follow-up showed that the use of inhaled corticosteroids (ICS) was on the rise and by the third month it was listed the second (10.74%). No significant difference (P=0.092> 0.05) was found among the the effect of drugs used alone but there was significant difference among combinations (P=0.006). Beta 2 agonists play a special role in the diagnosis and treatment of CVA. In UACS children, 49.80% cases used antimicrobial agents at first visit. Follow-up showed rapid decrease of antimicrobial usage and ICS use increased to the second position. Antihistamines and leukotriene combined with inhaled corticosteroids scheme had the best effect, 61.35% of PIC children were already given antimicrobial drugs before enrollment, compared with CVA (P=0.000 1) and the utilization rate declined with a clear diagnosis. The effects of beta lactams and macrolides had no significant difference (P=0.052). Conclusion The choices of treatment for chronic cough in Chinese children are diverse, which is related to overlapping in etiology, diagnosis and the regional drug sources and habits in use of drugs. Currently, leukotriene receptor antagonists are at the first place in children with chronic cough medicine, but its effect was not significantly different from those of beta 2 agonists, antihistamines monotherapy. ICS has not been widely recognized in the treatment of children with chronic cough, even in the CVA. Rational use of antimicrobial agents has been improved. Pediatricians′ understanding of chronic cough is being improved. We emphasize the principle of watching, waiting and follow-up in children with chronic cough. Effect on the determination of some CVA patients 1 to 3 months follow-up period is still too inadequate and may be considered appropriate to extend, while cases of multiple etiologies need to extend more observation and waiting time. Key words: Treatment; Cough; Child