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A novel and inviting therapeutic target?
Although asthma has its highest prevalence in childhood, it is generally less severe than in adolescents and adults.1 Whether the high population prevalence is because symptoms are more noticed by parents or whether the more physically active lifestyle and natural inquisitiveness of children, particularly young children, unmasks bronchial hyperresponsiveness and related symptoms remains elusive to investigation. Whatever the explanation, the population prevalence of asthma and associated symptoms including wheeze and cough remains high, although with recent evidence of stabilisation or even a decline in those countries (including the UK) at the top of national prevalence “league tables”.1–4
The investigation of underlying mechanisms is challenging in children because of ethical considerations and the limited applicability of invasive procedures such as bronchoscopy, bronchoalveolar lavage (BAL), and bronchial biopsy. In this context, the report by Li et al in the present issue of Thorax5 using the sputum induction technique raises a number of important issues and points to lines of investigation and management that merit further development.
As pointed out by Li et al,5 cough is a well recognised and frequent accompaniment of asthma and wheezing illness, although when an isolated and prominent symptom it is a poor predictor of subsequent wheezing illness and asthma.6,7 Cough can have important habit and psychogenic contributions, appears to be viewed as an important and worrying symptom by parents,8 and is poorly responsive to a range of popular and widely available “over the counter” treatments including antihistamines and antitussives,9 as well as inhaled corticosteroids.10 However, in the context of a confirmed diagnosis of asthma, cough is a well established although imprecisely quantifiable feature, unless assessed objectively by recording devices such as that described by Li et al.5 As …