Determinants of cough and caregivers' quality of life in pediatric asthma exacerbations

Objectives: In hospitalized and nonhospitalized children with asthma exacerbations, we evaluated the determinants of (a) prolonged cough on day-14 and (b) asthma quality of life (QoL) questionnaires for parents (PACQLQ) on day-21. We hypothesized that children with more severe acute asthma are more likely to have prolonged cough and/or poorer PACQLQ during the recovery phase. Design: Prospective cohort study performed during 2009–2011. Methodology: Two hundred and forty-four children aged 2–16 years presenting with acute asthma to the Emergency Departments of two hospitals were recruited. Clinical history, examination, baseline asthma severity, and acute asthma severity on presentation were documented. Validated daily cough diaries and weekly PACQLQ were recorded for 14 and 21 days, respectively. Results: 34.4% and 32.2% of children who returned the daytime and nighttime cough diaries respectively had a prolonged cough. Those on regular inhaled corticosteroids (ICS) were significantly more likely to have a daytime or nighttime cough score of ≥1 on day-14 (odds ratio [ORadjusted] = 4.70, 95% confidence interval [CI] 1.65, 13.35, p =.004 and ORadjusted = 2.65, 95% CI 1.05, 6.69, p =.040, respectively). PACQLQ on day-21 was significantly poorer in younger children (mean difference [MD] = −0.04 per year, 95% CI −0.08, −0.01, p =.016), those on ICS (MD = −0.31, 95% CI −0.52, −0.09, p =.005), leukotriene antagonists (MD = −0.42, 95% CI −0.83, −0.02, p =.040) and in those who had an unplanned visit for asthma on day-21 (MD = −1.20, 95% CI −1.61, −0.78, p =.0001). Conclusions: Post an acute asthma exacerbation, children on regular ICS were more likely to have prolonged cough and poorer QoL. While this may be reflective of asthma severity or control, its association deserves further evaluation.