Chest
Volume 140, Issue 2, August 2011, Pages 324-330
Journal home page for Chest

Original Research
Signs and Symptoms of Chest Diseases
Do Sex and Atopy Influence Cough Outcome Measurements in Children?

https://doi.org/10.1378/chest.10-2507Get rights and content

Background

Despite the commonality of cough and its burden, there are no published data on the relationship between atopy or sex on objectively measured cough frequency or subjective cough scores in children. In 202 children with and without cough, we determined the effect of sex and atopy on validated cough outcome measurements (cough receptor sensitivity [CRS], objective cough counts, and cough scores). We hypothesized that in contrast to adult data, sex does not influence cough outcome measures, and atopy is not a determinant of these cough measurements.

Methods

We combined data from four previous studies. Atopy (skin prick test), the concentration of capsaicin causing two and five or more coughs (C2 and C5, respectively), objectively measured cough frequency, and cough scores were determined and their relationship explored. The children's (93 girls, 109 boys) mean age was 10.6 years (SD 2.9), and 56% had atopy.

Results

In multivariate analysis, CRS was influenced by age (C2 coefficient, 5.9; P = .034; C5 coefficient, 29.1; P = .0001). Atopy and sex did not significantly influence any of the cough outcomes (cough counts, C2, C5, cough score) in control subjects and children with cough.

Conclusions

Atopy does not influence important cough outcome measures in children with and without chronic cough. However, age, but not sex, influences CRS in children. Unlike adult data, sex does not affect objective counts or cough score in children with and without chronic cough. Studies on cough in children should be age matched, but matching for atopic status and sex is less important.

Section snippets

Subjects

Children included in the data set for the present study were from several studies (Fig 1) as follows: control subjects and subjects from a study examining cough frequency and subjective cough (study a),23 children with cough from a randomized controlled trial (study b),4 control subjects and subjects from a study that evaluated cough to asthma exacerbation (20 with asthma, eight control subjects) (study c),24 and an unpublished study (children with cough and control subjects) evaluating the

Results

A total of 202 children were included in the present study (105 control subjects, 20 children with asthma, and 77 children with cough). For the entire group (93 girls, 109 boys), the mean age was 10.6 years (SD 2.9), and 113 (56%) had atopy. The respective group data (Table 1) showed significant differences between control subjects and children with cough with respect to age, CRS (C2 and C5), cough counts, and VAS cough score but no difference in atopy. Compared with control subjects, children

Discussion

In 202 children with and without cough, this study shows that sex does not influence objective cough counts or validated subjective cough scores in children. Our study has confirmed that in predominantly prepubertal children, CRS is not influenced by sex. Additionally, we show that atopy has no impact on cough outcome measures (CRS, objective cough counts, and VAS score).

Some pediatric epidemiology and clinic-based studies have described increased atopy in children with cough,28, 29 whereas

Acknowledgments

Author contributions: Dr Chang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Chang: contributed to the conception of the study, performed the data analysis, and drafted the manuscript.

Dr Gibson: contributed to the included studies and reviewed and contributed to the final manuscript.

Ms Willis: contributed to combining the data from the various cohorts and reviewed and contributed to the final

References (41)

  • AB Chang et al.

    A randomised, placebo controlled trial of inhaled salbutamol and beclomethasone for recurrent cough

    Arch Dis Child

    (1998)
  • AH Morice et al.

    ERS guidelines on the assessment of cough

    Eur Respir J

    (2007)
  • AB Chang et al.

    Airway hyperresponsiveness and cough-receptor sensitivity in children with recurrent cough

    Am J Respir Crit Care Med

    (1997)
  • SC Decalmer et al.

    Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring?

    Thorax

    (2007)
  • A Kelsall et al.

    Sex differences and predictors of objective cough frequency in chronic cough

    Thorax

    (2009)
  • M Fujimura et al.

    Female gender as a determinant of cough threshold to inhaled capsaicin

    Eur Respir J

    (1996)
  • AB Chang et al.

    Cough sensitivity in children with asthma, recurrent cough, and cystic fibrosis

    Arch Dis Child

    (1997)
  • S Varechova et al.

    Role of gender and pubertal stage on cough sensitivity in childhood and adolescence

    J Physiol Pharmacol

    (2008)
  • AB Chang et al.

    Cough receptor sensitivity in children with acute and non-acute asthma

    Thorax

    (1997)
  • M Fujimura et al.

    Comparison of atopic cough with cough variant asthma: is atopic cough a precursor of asthma?

    Thorax

    (2003)
  • Cited by (19)

    • Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report

      2021, Chest
      Citation Excerpt :

      In prepubertal children, cough sensitivity is similar in boys and girls and therefore not influenced by sex. However, heightened cough sensitivity has been documented in postpubertal adolescents and adult women compared with men.11 Exactly when children’s cough reflex becomes fully matured is unknown; however, it likely occurs in postpuberty.

    • Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report

      2020, Chest
      Citation Excerpt :

      This is not surprising as, while the physiology of the respiratory system in children and adults share similarities, there are also distinct differences between prepubertal children and adults that include maturational differences in airway, respiratory muscles and chest wall structure, sleep-related characteristics, respiratory reflexes and respiratory control.15-17 In the physiology of cough, sex differences in cough sensitivity are well recognized in adults18 but are absent in prepubertal children.19-21 In contrast to adults, cough sensitivity in children is instead influenced by airway caliber (FEV1) and age.20

    • The effect of adenoidectomy on cough reflex sensitivity in atopic children

      2018, Respiratory Physiology and Neurobiology
      Citation Excerpt :

      Atopy does not influence important cough outcome measures in children with and without chronic cough. In a study involving 202 children, atopy (defined by skin prick testing) did not influence cough receptor sensitivity to capsaicin (Chang et al., 2011). Based on this information, we could assume that atopy did not affect the cough.

    • Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report

      2017, Chest
      Citation Excerpt :

      This is not surprising, as although atopy increases the probability of having asthma, it presence or absence is a poor sole distinguishing feature for pediatric asthma.45 In a study involving 202 children, atopy (defined by skin prick testing) did not influence cough receptor sensitivity to capsaicin.46 One study36 undertaken in a setting with a high prevalence (relative to affluent countries) of tuberculosis found that sequential testing (including a Mantoux test) identified tuberculosis in 22% of the 94 children.

    View all citing articles on Scopus

    Funding/Support: Drs Chang and Gibson are funded by National Health and Medical Research Council practitioner fellowships [grants 545216 and 569240]. The Royal Children's Hospital Foundation and Queensland Children's Medical Research Institute funded Mss Willis and Petsky. Study d cited in this article was funded by the Asthma Foundation of Queensland.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    View full text