Chest
Volume 134, Issue 2, August 2008, Pages 303-309
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Original Research
Cough
What Is the Burden of Chronic Cough for Families?

https://doi.org/10.1378/chest.07-2236Get rights and content

Background

The burden of children's chronic cough to parents is largely unknown. The objectives of this study were as follows: (1) to determine the burden of chronic cough using a purposely designed questionnaire, and (2) to evaluate psychological (child's anxiety and parental emotional distress) and other influences on the reported burden of cough.

Methods

Parents of children newly referred for chronic cough completed three questionnaires (Spence anxiety scale; depression, anxiety, and stress 21-item scale [DASS]; and burden of cough questionnaire) at enrollment. The last 79 parents also completed these questionnaires at follow-up.

Results

Median age of the 190 children recruited was 2.6 years. The number of medical consultations for coughing illness in the last 12 months was high: > 80% of children had ≥ 5 doctor visits and 53% had > 10 visits. At presentation, burden scores correlated to parental DASS scores when their child was coughing. Stress was the largest contributor to parents' emotional distress. Parental anxiety and depression scores were within published norms. Scores on all three DASS subscales reduced significantly when the children ceased coughing. At follow-up, the reduction in burden scores was significantly higher in the “ceased coughing” group (n = 49) compared to the “still coughing” group (n = 32).

Conclusions

Chronic cough in children is associated with a high burden of recurrent doctor visits, parental stress, and worries that resolve when cough ceases. Parents of children with chronic cough did not have above-average anxiety or depression levels. This study highlights the need to improve the management of children with chronic cough, including clinicians being cognizant of the emotional distress of the parents.

Section snippets

Subjects

Children (aged < 18 years) newly referred for chronic cough (> 4 weeks)18 presenting to the Royal Children's Hospital, and one of their parents participated in this study. Data were collected on a standardized sheet where demographics were collected, subjective cough scores19 were obtained, and one parent (whoever was the primary caregiver for the child) answered three questionnaires (burden of cough; depression, anxiety, and stress 21-item scale [DASS];20, 21 and Spence children's anxiety

Results

Median age of the 190 children whose parents completed the questionnaires at presentation was 2.56 years (IQR, 1.13 to 5.91), and 55% (n = 104) were male. More than 80% of children had ≥ 5 visits to the doctor, and 53% (n = 101) made > 10 doctor visits for coughing illness in the last 12 months (Fig 1); 54% of parents (n = 103) had attended > 20 doctor appointments in their life for their child's coughing illness. The majority of parents (76%, n = 144) had consulted at least three different

Discussion

In this first study to systematically evaluate the burden of cough to parents of children with chronic cough, we found that the majority of parents sought repeated medical consultations from multiple specialists for their child's chronic cough. Burden scores correlated to measures of parental emotional distress using DASS21 of the parents when their child was coughing. Burden scores were significantly reduced when the child ceased coughing after intervention. The major contributor to the

Acknowledgment

The authors would like to sincerely thank the children and their parents who so willingly participated in the study. We also thank Drs. Masters, Francis, Dore, and Isles for allowing us to recruit their patients in this study, as well as Ria Halstead and Simone Taylor for data collection.

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    This research was conducted at the Brisbane Royal Children's Hospital.

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    1

    Dr. Marchant is supported by the Royal Children's Hospital Foundation, Brisbane, and the TSANZ/Allen and Hanbury's Paediatric Respiratory Medicine Career Development Fellowship.

    2

    Dr. Chang is funded by the Royal Children's Hospital Foundation and a Practitioner Fellowship from the National Health and Medical Research Council, Australia.

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