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      Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis

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          Abstract

          Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent’s quality of life was assessed as secondary outcome. In 36 children (2–8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children’s Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.

          Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed.

          What is Known:

          • Cough and wheezing are the predominant symptoms of acute bronchitis.

          • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies .

          What is New:

          • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies .

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          Most cited references25

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          Duration of symptoms of respiratory tract infections in children: systematic review

          Matthew Thompson, Talley A Vodicka, Peter Blair … (2013)
          Objective To determine the expected duration of symptoms of common respiratory tract infections in children in primary and emergency care. Design Systematic review of existing literature to determine durations of symptoms of earache, sore throat, cough (including acute cough, bronchiolitis, and croup), and common cold in children. Data sources PubMed, DARE, and CINAHL (all to July 2012). Eligibility criteria for selecting studies Randomised controlled trials or observational studies of children with acute respiratory tract infections in primary care or emergency settings in high income countries who received either a control treatment or a placebo or over-the-counter treatment. Study quality was assessed with the Cochrane risk of bias framework for randomised controlled trials, and the critical appraisal skills programme framework for observational studies. Main outcome measures Individual study data and, when possible, pooled daily mean proportions and 95% confidence intervals for symptom duration. Symptom duration (in days) at which each symptom had resolved in 50% and 90% of children. Results Of 22 182 identified references, 23 trials and 25 observational studies met inclusion criteria. Study populations varied in age and duration of symptoms before study onset. In 90% of children, earache was resolved by seven to eight days, sore throat between two and seven days, croup by two days, bronchiolitis by 21 days, acute cough by 25 days, common cold by 15 days, and non-specific respiratory tract infections symptoms by 16 days. Conclusions The durations of earache and common colds are considerably longer than current guidance given to parents in the United Kingdom and the United States; for other symptoms such as sore throat, acute cough, bronchiolitis, and croup the current guidance is consistent with our findings. Updating current guidelines with new evidence will help support parents and clinicians in evidence based decision making for children with respiratory tract infections.
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            The Leicester Cough Monitor: preliminary validation of an automated cough detection system in chronic cough.

            S S Birring, T. Fleming, S. Matos … (2008)
            Chronic cough is a common condition that presents to both primary and secondary care. Assessment and management are hampered by the absence of well-validated outcome measures. The present study comprises the validation of the Leicester Cough Monitor (LCM), an automated sound-based ambulatory cough monitor. Cough frequency was measured with the LCM and compared with coughs and other sounds counted manually over 2 h of a 6-h recording by two observers in nine patients with chronic cough in order to determine the sensitivity and specificity of the LCM. Automated cough frequency was also compared with manual counts from one observer in 15 patients with chronic cough and eight healthy subjects. All subjects underwent 6-h recordings. A subgroup consisting of six control and five patients with stable chronic cough underwent repeat automated measurements > or = 3 months apart. A further 50 patients with chronic cough underwent 24-h automated cough monitoring. The LCM had a sensitivity and specificity of 91 and 99%, respectively, for detecting cough and a false-positive rate of 2.5 events x h(-1). Mean+/-SEM automated cough counts x patient x h(-1) was 48+/-9 in patients with chronic cough and 2+/-1 in the control group (mean difference 46 counts x patient x h(-1); 95% confidence interval (CI) 20-71). The automated cough counts were repeatable (intra-subject SD 11.4 coughs x patient x h(-1); intra-class correlation coefficient 0.9). The cough frequency in patients undergoing 24-h automated monitoring was 19 coughs x patient x h(-1); daytime (08:00-22:00 h) cough frequency was significantly greater than overnight cough frequency (25 versus 10 coughs x patient x h(-1); mean difference 15 coughs x patient x h(-1), 95% CI 8-22). The Leicester Cough Monitor is a valid and reliable tool that can be used to assess 24-h cough frequency in patients with cough. It should be a useful tool to assess patients with cough in clinical trials and longitudinal studies.
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              An update on measurement and monitoring of cough: what are the important study endpoints?

              Arietta Spinou, Surinder Birring (2014)
              Considerable progress has been achieved in the development of tools that assess cough. The visual analogue scale (VAS) for cough severity is widely used in clinical practice because it's simple and practical. The Leicester cough questionnaire (LCQ) and the cough-specific quality of life questionnaire (CQLQ) are the most widely used health status questionnaires for adults with chronic cough. They are well validated for assessing the impact of cough. Cough can be assessed objectively with challenge tests that measure the sensitivity of the cough reflex. Cough challenge tests are better used to determine the mechanism of action of therapy, rather than efficacy. Cough frequency monitoring, the preferred tool to objectively assess cough, is increasingly being used as primary end-points in clinical trials. The most widely used cough monitors are the Leicester cough monitor (LCM) and VitaloJak. They are ambulatory devices that consist of a microphone and recording device. Cough frequency monitors do not reflect the intensity or the impact of cough; hence their relationship with subjective measures of cough is weak. Cough should therefore be assessed with a combination of subjective and objective tools. There is a paucity of studies that have investigated the minimal important difference of cough frequency monitors, rendering further investigations needed.
              Article 0 comments Cited 57 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Ulrich Koehler: 06421/5864962 , koehleru@med.uni-marburg.de
                Olaf Hildebrandt: olaf.hildebrandt@med.uni-marburg.de
                Patrick Fischer: patrick.fischer@ges.thm.de
                Volker Gross: volker.gross@ges.thm.de
                Keywan Sohrabi: Keywan.sohrabi@ges.thm.de
                Nina Timmesfeld: nina.timmesfeld@staff.uni-marburg.de
                Saskia Peter: saskia.pet@googlemail.com
                Christof Urban: urbanc@santa-maria.de
                Jens-Oliver Steiß: jens-oliver.steiss@paediat.med.uni-giessen.de
                Stephan Koelsch: stephan_koelsch@web.de
                Sebastian Kerzel: Sebastian.Kerzel@barmherzige-regensburg.de
                Andreas Weissflog: weissflog@thoratech.de
                Journal
                Journal ID (nlm-ta): Eur J Pediatr
                Journal ID (iso-abbrev): Eur. J. Pediatr
                Title: European Journal of Pediatrics
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0340-6199
                ISSN (Electronic): 1432-1076
                Publication date (Electronic): 18 July 2019
                Publication date PMC-release: 18 July 2019
                Publication date (Print): 2019
                Volume: 178
                Issue: 9
                Pages: 1385-1394
                Affiliations
                [1 ]ISNI 0000 0004 1936 9756, GRID grid.10253.35, Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, , Philipps-Universität, ; Baldingerstrasse 1, 35043 Marburg, Germany
                [2 ]ISNI 0000 0000 8919 8412, GRID grid.11500.35, Faculty of Health Sciences, , University of Applied Sciences, ; Gießen, Germany
                [3 ]ISNI 0000 0004 1936 9756, GRID grid.10253.35, Department of Medicine, Institute of Medical Biometry and Epidemiology, , Philipps-University Marburg, ; Marburg, Germany
                [4 ]Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
                [5 ]Alpenklinik Santa Maria, Oberjoch, Germany
                [6 ]ISNI 0000 0000 8584 9230, GRID grid.411067.5, Division of Pediatric Pulmonology and Allergy, Department of Pediatrics and Neonatology, , University Hospital of Marburg and Gießen, ; Gießen, Germany
                [7 ]GRID grid.420214.1, CHC Medical Affairs, Sanofi-Aventis Deutschland GmbH, ; Frankfurt am Main, Germany
                [8 ]Clinical Research Department, Thora Tech GmbH, Gießen, Germany
                Author notes

                Communicated by Peter de Winter

                Article
                Publisher ID: 3426
                DOI: 10.1007/s00431-019-03426-4
                PMC ID: 6694092
                PubMed ID: 31321530
                SO-VID: 7d5850f7-40ec-4a5c-9ef9-a3dca6c41b12
                Copyright © © The Author(s) 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 26 February 2019
                Date revision received : 2 July 2019
                Date accepted : 8 July 2019
                Funding
                Funded by: Sanofi-Aventis GmbH Germany
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                ScienceOpen disciplines: Pediatrics
                Keywords: cough,wheezing,acute bronchitis,acoustic long-term recording,time course
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: cough, wheezing, acute bronchitis, acoustic long-term recording, time course

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