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What Is the Burden of Chronic Cough for Families?^*

^* From the Department of Respiratory Medicine (Dr. Marchant), Royal Children’s Hospital, Brisbane, Australia; School of Psychology (Dr. Sheffield), University of Queensland, Brisbane, Australia; School of Social Work and Applied Human Sciences (Dr. Newcombe), University of Queensland, Australia; Department of Clinical Epidemiology and Biostatistics (Ms. Juniper), McMaster University, ON, Canada; University of Queensland (Dr. Stathis), Child and Family Mental Health Unit, Royal Children’s Hospital, Brisbane, Australia; and Menzies School of Health Research (Dr. Chang), Darwin, Australia.

Correspondence to: Julie M. Marchant, MBBS, Department of Respiratory Medicine, Royal Children’s Hospital, Herston, 4029, Queensland, Australia; e-mail: jmarchant{at}ausdoctors.net

Abstract

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.

Key Words: anxiety • burden • children • chronic cough • depression • quality of life • stress