Survey on attitudes of Italian pediatricians toward cough

Alessandro Zanasi, Luigi Morcaldi, Salvatore Cazzato, Massimiliano Mazzolini, Marzia Lecchi, Antonio Maria Morselli-Labate, Marianna Mastroroberto, Roberto W Dal Negro, Alessandro Zanasi, Luigi Morcaldi, Salvatore Cazzato, Massimiliano Mazzolini, Marzia Lecchi, Antonio Maria Morselli-Labate, Marianna Mastroroberto, Roberto W Dal Negro

Abstract

Context: Children's cough is a daily concern for most pediatricians. The management of both acute and chronic cough requires a systematic and comprehensive approach. Despite the approved protocols for management, the pediatric assessment of cough and the corresponding prescribing attitude frequently do not fit these protocols, which can be affected by parental suggestions - sometimes substantially.

Objective: The objective of this study was to investigate both the perception and the behavior of a representative sample of Italian pediatricians toward cough in real life.

Methods: A specific questionnaire consisting of 18 questions was prepared. The questionnaire was completed by 300 pediatricians (all members of PAIDOSS: Italian National Observatory on Health of Childhood and Adolescence) who represented ~300,000 children.

Results: A vast majority of children have cough throughout the year (99.3% of respondents have cough during autumn/winter and 64.7% in spring/summer). Allergic disease is the most frequent suspected cause of chronic cough in children (53%), and this is supported by the high demand for consultations: 73% seek the opinion of allergologists, 62% of otorhinolaryngologists and only 33% of pulmonologists. The majority of pediatricians (92%) reported that they prescribe therapy in acute cough regardless of cough guidelines. Moreover, the survey pointed out the abuse of aerosol therapy (26% in acute cough and 38% in chronic cough) and of antibiotics prescription (22% in acute cough and 42% in chronic cough).

Conclusion: Our survey suggests that some Italian pediatricians' therapeutic attitudes should be substantially improved in order to achieve better management of cough in children and to minimize the burden of cough.

Keywords: acute cough; chronic cough; cough impact; cough in children; pediatricians’ prescriptions.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5358962/bin/ceor-9-189s1.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5358962/bin/ceor-9-189s2.jpg
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5358962/bin/ceor-9-189s3.jpg

References

    1. Chang AB, Robertson CF, Van Asperen PP, et al. A multicenter study on chronic cough in children : burden and etiologies based on a standardized management pathway. Chest. 2012;142:943–950.
    1. Smith MD, Spiller HA, Casavant MJ, Chounthirath T, Brophy TJ, Xiang H. Out-of-hospital medication errors among young children in the United States, 2002-2012. Pediatrics. 2014;134(5):867–876.
    1. Chang AB, Robertson CF, van Asperen PP, et al. A cough algorithm for chronic cough in children: a multicenter, randomized controlled study. Pediatrics. 2013;131(5):e1576–e1583.
    1. Risk R, Naismith H, Burnett A, Moore SE, Cham M, Unger S. Rational prescribing in paediatrics in a resource-limited setting. Arch Dis Child. 2013;98:503–509.
    1. Picciotto A, Hubbard M, Sturdy P, Naish J, McKenzie SA. Prescribing for persistent cough in children. Respir Med. 1998;92(4):638–641.
    1. Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D. Trends of outpatient prescription drug utilization in US children, 2002–2010. Pediatrics. 2012;130:23–31.
    1. Gulliford MC, Dregan A, Moore MV, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open. 2014;4(10):e006245.
    1. Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics. 2011;128(6):1053–1061.
    1. Schindler C, Krappweis J, Morgenstern I, Kirch W. Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years. Pharmacoepidemiol Drug Saf. 2003;12(2):113–120.
    1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096–c2096.
    1. Goossens H. Antibiotic consumption and link to resistance. Clin Micro-biol Infect. 2009;15(suppl 3):12–15.
    1. Oppong R, Coast J, Hood K, Nuttall J, Smith RD, Butler CC, GRACE-01 Study Team Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges. Eur J Health Econ. 2011;12(4):319–329.
    1. Hollinghurst S, Gorst C, Fahey T, Hay AD. Measuring the financial burden of acute cough in pre-school children: a cost of illness study. BMC Fam Pract. 2008;9:10.
    1. McCallum GB, Bailey EJ, Morris PS, Chang AB. Clinical pathways for chronic cough in children. Cochrane Database Syst Rev. 2014;9:CD006595.
    1. Chang AB, Oppenheimer JJ, Weinberger M, Weir K, Rubin BK, Irwin RS. Use of management pathways or algorithms in children with chronic cough: systematic reviews. Chest. 2016;149(1):106–119.
    1. Rousounidis A, Papaevangelou V, Hadjipanayis A, et al. Descriptive study on parents’ knowledge, attitudes and practices on antibiotic use and misuse in children with upper respiratory tract infections in Cyprus. Int J Environ Res Public Health. 2011;8:3246–3262.
    1. Vinson DC, Lutz LJ. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Pract. 1993;37(1):23–27.
    1. Morice AH. Epidemiology of cough. Pulm Pharmacol Ther. 2002;15(3):253–259.
    1. Kauffmann F, Varraso R. The epidemiology of cough. Pulm Pharmacol Ther. 2011;24(3):289–294.
    1. Dicpinigaitis PV, Eccles R, Blaiss MS, Wingertzahn MA. Impact of cough and common cold on productivity, absenteeism, and daily life in the United States: ACHOO Survey. Curr Med Res Opin. 2015;31(8):1519–1525.
    1. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):260S–283S.
    1. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R, British Thoracic Society Cough Guideline Group BTS guidelines: recommendations for the assessment and management of cough in children. Thorax. 2008;63:iii1–iii15.
    1. Gibson PG, Chang AB, Glasgow NJ, et al. CICADA: cough in children and adults: diagnosis and assessment. Australian cough guidelines summary statement. Med J Aust. 2010;192(5):265–271.
    1. Morice AH. The diagnosis and management of chronic cough. Eur Respir J. 2004;24:481–492.
    1. Worrall G. Acute cough in children. Can Fam Physician. 2011;57:315–318.
    1. Asthma and respiratory symptoms in 6–7 yr old Italian children: gender, latitude, urbanization and socioeconomic factors. SIDRIA (Italian Studies on Respiratory Disorders in Childhood and the Environment) Eur Respir J. 1997;10(8):1780–1786. No authors listed.
    1. Usta Guc B, Asilsoy S, Durmaz C. The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: descriptive, prospective, clinical trial. Clin Respir J. 2014;8(3):330–337.
    1. Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children with chronic wet or productive cough-treatment and investigations: a systematic review. Chest. 2016;149:120–142.
    1. Smith SM, Fahey T, Smucny J, Becker LA. Antibiotics for acute bronchitis. Cochrane Database Syst Rev. 2014;3:CD000245.
    1. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev. 2013;6:CD000247.
    1. Zanasi A, Cazzato S, Mazzolini M, et al. Does additional antimicrobial treatment have a better effect on URTI cough resolution than homeopathic symptomatic therapy alone? A real-life preliminary observational study in a pediatric population. Multidiscip Respir Med. 2015;10(1):25.
    1. Zanasi A, Lanata L, Fontana G, Saibene F, Dicpinigaitis P, De Blasio F. Levodropropizine for treating cough in adult and children: a meta-analysis of published studies. Multidiscip Respir Med. 2015;10(1):19.
    1. Zanasi A, Cazzato S, Aprile A, Mazzolini M, Zenezini C, Pandolfi P. Are antibiotics effective in treating children with acute moist cough? A retrospective study vs symptomatic therapy. Multidiscip Respir Med. 2012;7:I–V.
    1. Ashworth M, White P, Jongsma H, Schofield P, Armstrong D. Antibiotic prescribing and patient satisfaction in primary care in England: cross-sectional analysis of national patient survey data and prescribing data. Br J Gen Pract. 2016;66(642):e40–e46.
    1. Bernard DW, Goepp JG, Duggan AK, Serwint JR, Rowe PC. Is oral albuterol effective for acute cough in non-asthmatic children? Acta Paediatr. 1999;88(4):465–467.
    1. Smucry JJ, Flynn CA, Becker LA, Glazier RH. Are b2 agonists effective treatment for acute bronchitis or acute cough in patients without underlying pulmonary disease? A systematic review. J Fam Pract. 2001;50:945–951.
    1. Hampton LM, Nguyen DB, Edwards JR, Budnitz DS. Cough and cold medication adverse events after market withdrawal and labeling revision. Pediatrics. 2013;132(6):1047–1054.
    1. Brightling CE. Chronic cough due to nonasthmatic eosinophilic bronchitis: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):116S–121S.
    1. Dicpinigaitis PV. Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 suppl):75S–79S.
    1. Pratter MR. Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):63S–71S.
    1. Pecova R, Zucha J, Pec M, Neuschlova M, Hanzel P, Tatar M. Cough reflex sensitivity testing in in seasonal allergic rhinitis patients and healthy volunteers. J Physiol Pharmacol. 2008;59(suppl 6):557–564.

Source: PubMed

3
Abonnieren