Chronic cough in children: the etiology and medical history of 420 cases in Shanghai

Chronic cough in children: the etiology and medical history of 420 cases in Shanghai | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Chronic cough in children: the etiology and medical history of 420 cases in Shanghai Yonghong Jiang, Zhiyan Jiang, Zhoujian Yang, Junxia Li, Liming Mao, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-64375/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Chronic cough is one of the most common and frequently-occurring diseases in children. We investigated the etiologies and clinical features of children with chronic cough (CC), in order to improve the diagnostic and treatment of the disease by pediatricians. Methods The clinical data of 420 cases of children, aged 1–14 years old, from 5 hospitals’ Outpatient Department in different regions of Shanghai, who suffered from chronic cough between the period of September 2017 and July 2019 were prospectively analyzed. Children with chronic cough were enrolled to identify the specific cause and clinical information based on a questionnaire survey. All the data were collected and statistically analyzed by Chi-square test to identify the constituent ratio of each cause. Results The etiology component ratio showed that 146 cases (34.8%) had post-infection cough (PIC); 96 cases (22.9%) had upper airway cough syndrome (UACS); 90 cases (21.4%) had cough variant asthma (CVA); 75 cases (17.9%) had allergic (atopic) cough (AC); 11 cases (2.6%) had tourette cough (TS); 2 cases (0.5%) had gastroesophageal reflux cough (GERD). For the children with CC, the mainly age of onset is 3–6 years (54.05%). The mainly cough character is wet cough (65.7%). 67.1% of children with chronic cough were prescribed antibiotics, of which 41.7% were azithromycin. Various cough drops, antihistamines, aerosolized inhalation, montelukast, etc. were often used in the treatment of children's chronic cough. Conclusion The leading 3 causes of chronic cough in children were PIC, UACS and CVA. The mainly age of onset is 3–6 years; mainly cough character is wet cough. Antibiotics are the mainly treatment, often combined with cough medicine and atomization. Parasitology chronic cough children etiology medication history Shanghai 1. Background Chronic cough is one of common and frequently-occurring diseases in children. It refers to those who cough for more than 4 weeks [ 1 ], cough is the main or only clinical manifestation, and chest film shows no obvious abnormality. According to the nature of cough, it can be divided into dry cough and wet cough. A long-term cough without definite diagnosis and repeated use of antibiotics will cause significant impairment to the quality of life, including children’s sleep, school attendance and play and parents’ experience distress and anxiety [ 2 – 4 ]. Therefore, we studied the constituent ratio of various causes of chronic cough in children, analyzed and sorted out their medication history, in order to improve the diagnosis and treatment of non-specific chronic cough by pediatricians. 2. Materials And Methods 2.1 Study population The survey was carried out in the Outpatient Department of five hospitals in different regions of Shanghai, including Longhua Hospital of Shanghai University of TCM, Pudong New District Hospital of TCM, Fengxian District Hospital of TCM, Jiading District Hospital of TCM, Shanghai Seventh People's Hospital. Prior to the start of the project, training sessions on research plan and questionnaires will be held. After that, 420 children with chronic cough who met the diagnostic criteria were collected and analyzed statistically. 2.2 Selection criteria The inclusion criteria was:1) a cough of > 4 weeks duration; 2) cough is the main clinical manifestation; 3) aged 1–14 years old; 4) there was no abnormalities in the chest X-ray film[ 1 ]. The exclusion criteria was:1) children had abnormal chest X-ray; 2) had serious systemic diseases; and 3) unwilling/unable to cooperate with researchers to complete the questionnaire. 2.3 Survey development Each of the patients underwent the following procedures for the investigation of the cause of cough: 1) recording of medical history including symptoms and history of ear, nose, throat, respiratory tract, and digestive tract problems; 2) detailed physical examination with the targeted evaluation of throat congestion, follicular hyperplasia, and retropharyngeal postnasal drip; and 3) allergen test, chest X-ray examination, routine blood test, pulmonary function assessment and gastrointestinal dynamic ultrasound in patients with suspicious symptoms or signs. 2.4 Methods The diagnosis of the etiology of all children with non-specific chronic cough was referenced to the diagnosis and differential diagnosis of chronic cough in children guidelines[ 1 , 5 – 7 ]. Each of the patients underwent the following procedures for the investigation of the cause of cough: 1) detailed recording of medical history(duration and nature of the cough, associated symptoms, the history of medication, family history of allergic disease or related disease and information about the living environment of the patient); 2) detailed physical examination with particular attention to the heart and lower and upper airways; and 3) allergen test, routine blood test, chest X-ray examination, Pulmonary function assessment, gastrointestinal dynamic ultrasound in patients with suspicious symptoms or signs 2.5 Analyses SPSS 24.0 was used to calculate the incidence rates of the clinical characteristics. The percentage of distribution of causes/medical history of each group was expressed by the percentage of ascertained causes/ medical history of each group to the total number of causes/ medical history of each group. The chisquare ( X 2 ) test was used to evaluate the variable. Statistical significance was defined as a two-tailed P-value less than 0.05. 3. Results The General conditions: The 420 study subjects included 235 male (55.9%) and 185 female (44.1%) patients, with an average age of 5.67 ± 2.59 years. 3.1. The etiological composition and cough character Table 1 showed etiological composition and cough character of chronic cough. The number of children between 1 years and 3 years was 48 (11.4%), the number of children between 3 years and 6 years was 227 (54.0%), and the number of children between 6 years and 14 years old was 145 (34.5%). Table 1 Comparison of etiological composition and cough character of chronic cough in Children Item n PIC CVA UACS AC TS GERD X 2 p Age 1 ~ 3 48 17(35.4) 8(16.7) 12(25.0) 9(18.7) 1(2.1) 1(2.1) 11.242 0.339 ~ 6 227 86(37.9) 43(18.9) 48(21.1) 45(19.8) 5(2.2) 0(0.0) ~ 14 145 43(29.7) 39(26.9) 36(24.8) 21(14.5) 5(3.4) 1(0.7) Cough character Dry 144 36(25.0) 41(28.5) 24(16.7) 34(23.6) 8(5.6) 1(0.7) 25.948 < 0.001 Wet 276 110(39.9) 49(17.8) 72(26.1) 41(14.9) 3(1.1) 1(0.4) Total -- 420 146(34.8) 90(21.4) 96(22.9) 75(17.9) 11(2.6) 2(0.5) -- -- Etiological composition of chronic cough: PIC is the most common (34.8%) cause of chronic cough in children of 1–14 years old, followed by UACS (22.9%), CVA (21.4%), AC (17.9%), TS (2.6%) and GERD (0.5%). Among these, in the young children (1–3 years old), the sequence of the common cause of chronic cough was PIC (35.4%), UACS (25.0%), CVA (16.7%), AC (18.7%), GERC (2.1%) and TS (2.1%). In the preschool children (3–6 years old), the sequence of the common cause of nonspecific chronic cough was PIC (37.9%), UACS (21.1%), AC (19.8%), CVA (18.9%), TS (2.2%) and GERD (0.0%). In the school-age children (6–14 years old), the sequence of the common cause of nonspecific chronic cough was PIC (29.7%), CVA (26.9%), UACS (34.8%), AC (14.5%), TS (3.4%) and GERD (0.7%). There was no significant difference in etiological components among different ages (P > 0.05). In respect of cough character, 144 children (34.3%) were dry cough, and 276 children (65.7%) were wet cough. The common causes of wet cough were PIC (39.9%), UACS (26.1%), CVA (17.8%), AC (14.9%), TS (1.1%) and GERD (0.4%).The common causes of dry cough were CVA (28.5%), PIC (25.0%), AC (23.6%), UACS (16.7%), TS (5.6%) and GERD (0.7%).There was a significant difference in the cause of dry cough and wet cough (P༜0.001) . 3.2. The attack time and associated symptoms Table 2 showed attack time and associated symptoms of chronic cough. The clinical manifestations of the patients in the PIC group included nasal congestion and runny nose. The patients in the CVA group presented with cough at night,in the morning, after exercise as the most characteristic feature. The clinical signs of the patients in the UACS group included cough in the morning, at night, nasal congestion, runny nose and sneezing. The patients in the AC group typically exhibited cough in the morning, in the evening and itchy throat. The characteristics of TS cough group were cough in daytime and disappear after sleep, accompanied by throat itching and throat clearing. The patients in the GERD group showed typical acid regurgitation. Table 2 The attack time and associated symptoms of children with nonspecific chronic cough Item PIC CVA UACS AC TS GERD n 146 90 96 75 11 2 Attack time morning 91(62.3) 59(65.5) 62(64.6) 40(53.3) 6(54.5) 1(50.0) afternoon 42(28.8) 3(3.3) 9(9.4) 13(17.3) 6(54.5) 0(0) evening 55(37.7) 1(1.1) 45(46.9) 38(50.7) 7(63.6) 1(50.0) night 76(52.1) 73(81.1) 6(6.3) 11(14.7) 0(0) 1(50.0) After exercise 31(21.2) 39(43.3) 13(13.5) 33(44.0) 3(27.2) 1(50.0) Associated Symptoms nasal congestion 87(59.6) 16(17.8) 73(76.0) 13(17.3) 0(0.0) 0(0.0) runny nose 75(51.4) 0(0.0) 61(63.5) 6(8.0) 0(0.0) 0(0.0) sneezing 57(39.0) 12(13.3) 63(65.6) 24(32.0) 2(18.1) 0(0.0) itchy throat 57(39.0) 18(20.0) 28(29.2) 67(89.3) 7(63.6) 1(50.0) feeling of mucus attachment 29(19.9) 3(3.3) 45(46.8) 27(36.0) 0(0.0) 0(0.0) Snoring 20(13.7) 19(21.1) 21(21.9) 12(16) 4(36.3) 0(0.0) sour regurgitation 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 2(100.0) sigh 2(1.4) 0(0.0) 0(0.0) 1(1.3) 2(18.1) 0(0.0) molar 2(1.4) 0(0.0) 0(0.0) 0(0.0) 3(27.3) 0(0.0) 3.3. The medication history Table 3 showed the medication history of children with chronic cough. 281 children (67.1%)had a history of using Antimicrobial, 158 children (37.6%) had a history of using cough medication, 191 children (45.5%) had a history of using antihistamine, 136 children (32.4%) had a history of using Montelukast, 120 children (28.6%) had a history of using atomization inhalation preparation and 60 children (14.3%) had a history of using nasal spray. Table 3 The medication history of children with nonspecific chronic cough (n = 420) Total sample n(%) Have medication history 371(88.3) Antimicrobials had used 281(67.1) Azitromycin 175(41.7) Clarithromycin 13(3.1) Penicillin 5(1.2) First-generation cephalosporin 4(1.0) Second-generation cephalosporin 94(22.4) Third-generation cephalosporin 56(13.3) Cough Medication have used 158(37.6) Procaterol 133(31.7) Apophlegmatisant 32(7.6) Antihistamine 191(45.5) Montelukast 136(32.4) Inhalation preparation 120(28.6) Nasal spray 60(14.3) Chinese patent drug 185(44.1) Chinese herbal medicine 264(62.9) Among Antimicrobials, 175 children (41.7%) had a history of using azithromycin, 13 children (3.1%) had a history of using clarithromycin. 5 children (1.2%) had a history of using penicillin. 154 children (36.7%) had a history of using β-lactam antibiotics. Among cough medications, 133 children (31.7%) had a history of using Procaterol and 32 children (7.6%) had a history of using apophlegmatisant. Among atomization inhalation preparation, 120 children (28.5%) had a history of using terbutaline combined with budesonide, 2 children had a history of using Seretide. 185 children (44.1%) had a history of using Chinese patent drug. 264 children (62.9%) had a history of using Chinese herbal medicine. 3.4. The past medical history, allergic history, family medical history and living environment Table 4 showed the past medical history, allergic history, family medical history and living environment of children with nonspecific chronic cough. 273 children (65.0%) had past medical history, including 133 cases of eczema history (31.7%), 139 cases of rhinitis history (33.1%), 38 cases of adenoid vegetation history (9.0%), 33 cases of pneumonia history (7.8%), 13 cases of anaemia history (3.1%), 5 cases of gastritis history (1.2%) and 3 cases of obesity history (0.7%). Table 4 The past medical history, allergic history, family medical history and living environment of children with chronic cough (n = 420) Total sample n (%) Past medical history eczema 133(31.7) rhinitis 139(33.1) adenoid vegetation 38(9.0) pneumonia 33(7.8) anaemia 13(3.1) gastritis 5(1.2) obesity 3(0.7) Allergic history dust mites 21(5.0) egg 20(4.8) milk 18(4.3) seafood 7(1.7) nut 7(1.7) pollen 3(0.7) beef/mutton 3(0.7) animal hairs 3(0.7) others 6(1.4) Family medical history rhinitis 68(16.2) asthma 16(3.8) passive smoking 133(31.7) cultivate plants 134(31.9) Living environment keep pets 22(5.2) along the street 105(25.0) 63 children (15.0%) had allergic history, including 21 dust mites-allergic children (5.0%), 20 egg-allergic children (4.8%), 18 milk-allergic children (4.3%), 7 seafood-allergic children (1.7%), 7 nut-allergic children (1.7%), 3 pollen-allergic children (0.7%), 3 beef/mutton-allergic children (0.7%), 3 animal hairs-allergic children (0.7%) and 6 allergy to other substances (1.4%, 2 mango-allergic children, 1 chocolate-allergic child, 1 chicken-allergic child, 1 mycete-allergic child, 1 Penicillin-allergic child). 84 cases (20.0%) had family medical history, including 68 cases of family rhinitis history (16.2%), 16 cases of family asthma history (3.8%). 133 children’s family (31.7%) had smokers among the surrounding.134 families (31.9%) grew plants. 22 families (5.2%) kept pets.105 children’s (25.0%) home was along the street. 4. Discussion 4.1. The etiology of chronic cough In 2009, the top 3 causes of chronic cough were GERC, asthma, asthma-like diseases and AC in children of the United States [ 8 ]. In 2012, the “Prospective multicenter clinical study on the etiology component ratio of chronic cough in Chinese children” revealed that [ 9 ] the sequence of top 3 causes of chronic cough were CVA, UACS and PIC in Chinese children. What’s more, PIC was the most common cause in children under 6 years old. Kantar Ahmad [ 10 ] et al suggested chronic cough in preschool children is caused by protracted bacterial bronchitis (PBB), tracheobronchomalacia, foreign body aspiration, PIC or some combination of the above in most cases in Europe. They and ACCP [ 11 ] recommend that when evaluating and managing children’s chronic cough, their age and the clinical settings should be taken into consideration. The present study found that PIC (34.8%) was the most common cause of chronic cough in children in Shanghai, and UACS (22.9%) and CVA (21.4%) ranked second and third in the composition ratio of etiology, respectively. In this study average age of children was 5.67 ± 2.59 years (under 6 years old), which matched the result of the research in China in 2012. In analysis of the causes, the differences in the proportion of causes of disease may be related to the ethnic group, society environment, living habits and age structure. 4.2. The medication history of children with chronic cough We collected the medication history of children in the course. The present study shows most children (67.1%) had a history of using antimicrobials. Studies showed using appropriate antibiotics improves cough resolution, especially for the chronic wet cough [ 12 – 15 ]. 175 children (41.7%) had taken Azitromycin in the course. Mycoplasma pneumoniae is extensively regarded as major cause for CVA in clinics [ 16 ]. Hodgson David [ 17 ] et al found that Antimicrobial may have a place in the treatment of chronic cough associated with asthma. Martin Matthew J [ 18 ] et al found that those chronic cough patients, who were similar to the pediatric condition protracted bacterial bronchitis, had a good symptoms' response to low-dose azithromycin. What’s more, Azithromycin has a well-described anti-inflammatory properties which can be attributed to the interactions with cPLA₂, causing inadequate translocation of the enzyme or disturbing physical interactions with its substrates[ 19 ]; or attributed to the inhibition of the STAT1 and NF-κB signaling pathways through the drug's effect on p65 nuclear translocation and IKKβ[ 20 ]. Thus, Many pediatrician chose azithromycin to treat chronic cough. 206 children (49.0%) had a history of using cough medications. 136 children (32.4%) had a history of using Montelukast. Miwa Nanako [ 21 ] et al found that leukotriene receptor antagonist (LTRA) was useful in improving cough in patients with CVA. Tamaoki Jun [ 22 ] et al found that LTRA was more effective than the salmeterol in the treatment of CVA. Whereas it was not effective in non-productive cough in AC[ 23 ]. 185 children (44.1%) had taken Chinese patent drug. This showed that Chinese pediatrician prefer to use Chinese patent drug to relieve cough symptoms. 62.9% children had taken Chinese herbal medicine. There was a great variety of Chinese patent drug, and Chinese herbal medicine were mostly compound. Although they had certain curative effect in clinic, the mechanism was not clear. 4.3. The living environment of children with chronic cough We found 133 children’s family (31.7%) had smokers among the surrounding. Çolak Yunus[ 24 ] et al found that smoking is one of the chronic cough risk factors. The prevalence of chronic cough in the current smokers was 8%. Johannessen Ane[ 25 ] et al believed that exposure to environmental tobacco smoke (ETS) is associated with impaired lung function in childhood. ETS might be one of the chronic cough risk factor. 105 children’s (25.0%) home were along the street. Fang Zhangfu[ 26 ] et al found that the traffic-related air pollution (TRAP) exposures induced cough hypersensitivity and non-allergic eosinophilic inflammation of airways in guinea-pigs. De Sajal [ 27 ] et al found that shopkeepers working in heavily trafficked roadside shops suffer from respiratory morbidity and the risk increases with higher total exposure period. We believe TRAP might be one of the chronic cough risk factor; this is worthy of further investigation. 5. Conclusion Among children aged 1–14, the leading 3 causes of chronic cough in Shanghai were PIC, UACS and CVA. The mainly age of onset is 3–6 years. The mainly cough character is wet cough. By collecting the medical history of children in the course, we found antibiotics are the mainly treatment, often combined with cough medicine and atomization. Azithromycin is the most commonly used antibiotic. More than half of the children used to seek traditional Chinese medicine treatment. Abbreviations AC, allergic (atopic) cough; CC, chronic cough ; CVA, cough variant asthma; GERC, gastroesophageal reflux cough; PIC, post-infection cough; TS, tourette cough; UACS, upper airway cough syndrome. Declarations Acknowledgements We acknowledge nursing staff of Pediatric Unit for their assistance in the care of the patient and her family. We thank all the families that were involved in the study. Authors’ contributions Conceptualization: Yonghong Jiang. Data curation: Yiliu Chen, Shuqin Wang, Chengxu Zhang. Formal analysis: Yiliu Chen, Shuqin Wang. Funding acquisition: Yonghong Jiang. Investigation : Yonghong Jiang, Zhiyan Jiang, Zhoujian Yang, Junxia Li, Liming Mao, Jingwen Gu, Yiliu Chen, Shuqin Wang, Chengxu Zhang. Methodology : Yonghong Jiang. Project administration : Yonghong Jiang, Zhen Xiao. Supervision: Yonghong Jiang, Zhen Xiao. Writing: Yiliu Chen, Yonghong Jiang. Funding Shanghai Shenkang, Grant/Award Number: 16CR4032A Shanghai Municipal Key Clinical Specialty, Grant/Award Number: shslczdzk04102 Availability of data and materials Not applicable. Ethics approval and consent to participate Written informed consent was obtained after detailed explanation of the study aim from the patient’s parents. Parents could withdraw consent in any moment during the study. Consent for publication Not applicable. Competing interest The authors have no financial relationships related to this work to disclose. The authors declare that there are no conflicts of interest. References Chang AB, GlombWB. 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JAllergy Asthma Proc. 2010;31:78–84. Kita Toshiyuki F, Masaki O, Haruhiko, et al. Antitussive effects of the leukotriene receptor antagonist montelukast in patients with cough variant asthma and atopic cough. JAllergol Int. 2010;59:185–92. Çolak Yunus N, Børge G, Laursen Lars C, et al. Risk Factors for Chronic Cough Among 14,669 Individuals From the General Population. JChest. 2017;152:563–73. Johannessen Ane, Bakke Per S, Hardie Jon A, et al. Association of exposure to environmental tobacco smoke in childhood with chronic obstructive pulmonary disease and respiratory symptoms in adults. JRespirology. 2012;17:499–505. Fang Zhangfu H, Chuqin ZJ, Jim, et al. Traffic-related air pollution induces non-allergic eosinophilic airway inflammation and cough hypersensitivity in guinea-pigs.J. Clin Exp Allergy. 2019;49:366–77. De Sajal KGaganD, Singh D, Dharmendra, et al. Respiratory Morbidity of Roadside Shopkeepers Exposed to Traffic-related Air Pollution in Bhopal, India. JJ Health Pollut. 2019;9:190305. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-64375","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":2039830,"identity":"862112fb-da48-4b98-afe3-35672a2ab2c5","order_by":0,"name":"Yonghong Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACxgYexgcJP2zk7NsbGx98IFILs8HHnjRjA57DzYYziLOHh01yBtvhxA0S6W3SHMRoYJ6Re0Cah4eZcbvkwwZpBgY7Od0GQg6bkZdgzGPBxmw5O7HBuIAh2djsAEEtOQbJPDw8bAy3ExuSZzAcSNxGjJbDPGwSPAw3DzYc5iFSi2HjDDYDCYMbjI3NxGnpeWPM8LEnwUCyJ7GZcYYBEX4xbM8x/5Hw4399P/vx5z8+VNjJEdYyIQGZa0BAOQjI8xMydBSMglEwCkYBAJ+1Rb6ejwd+AAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-1238-2723","institution":"Longhua hospital of shanghai university of traditional Chinese medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yonghong","middleName":"","lastName":"Jiang","suffix":""},{"id":2039831,"identity":"3d8a63d2-cc94-4f92-a1de-effec507262d","order_by":1,"name":"Zhiyan Jiang","email":"","orcid":"","institution":"Longhua Hospital of Shanghai University of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhiyan","middleName":"","lastName":"Jiang","suffix":""},{"id":2039832,"identity":"d50ce69f-135b-4e8e-8883-edbf1aca5126","order_by":2,"name":"Zhoujian Yang","email":"","orcid":"","institution":"Pudong New District Hospital of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhoujian","middleName":"","lastName":"Yang","suffix":""},{"id":2039833,"identity":"b0da99d2-b52c-4681-b408-4d670b026c39","order_by":3,"name":"Junxia Li","email":"","orcid":"","institution":"Fengxian District Hospital of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Junxia","middleName":"","lastName":"Li","suffix":""},{"id":2039834,"identity":"8fb338df-6049-4a5d-a13e-cdcef7bbcf2f","order_by":4,"name":"Liming Mao","email":"","orcid":"","institution":"Jiading District Hospital of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Liming","middleName":"","lastName":"Mao","suffix":""},{"id":2039835,"identity":"cf7dbada-adf4-4c7d-bf31-5b0670b8d50b","order_by":5,"name":"Jingwen Gu","email":"","orcid":"","institution":"Shanghai Seventh People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jingwen","middleName":"","lastName":"Gu","suffix":""},{"id":2039836,"identity":"c0cbc9d3-ac20-47d2-adbb-d34f3aba5fdd","order_by":6,"name":"Yiliu Chen","email":"","orcid":"","institution":"Longhua Hospital of Shanghai University of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yiliu","middleName":"","lastName":"Chen","suffix":""},{"id":2039837,"identity":"7ae8d1bd-3eed-4bb7-9f4f-13e2a65ab8a1","order_by":7,"name":"Shuqin Wang","email":"","orcid":"","institution":"Longhua Hospital of Shanghai University of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Shuqin","middleName":"","lastName":"Wang","suffix":""},{"id":2039838,"identity":"37f8af17-9aa6-445a-9b6b-adbc97403e43","order_by":8,"name":"Sunguk Jang","email":"","orcid":"","institution":"Longhua hospital of Shanghai University of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sunguk","middleName":"","lastName":"Jang","suffix":""},{"id":2039839,"identity":"2d5aeff8-d565-4c9f-b899-da10ae6be7c7","order_by":9,"name":"Zhen Xiao","email":"","orcid":"","institution":"Longhua Hospital of Shanghai University of TCM","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Xiao","suffix":""}],"badges":[],"createdAt":"2020-08-23 11:26:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-64375/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-64375/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13589622,"identity":"ca9fa385-6632-488e-946a-32384e98d493","added_by":"auto","created_at":"2021-09-17 05:01:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":454963,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-64375/v1/4a10dcc4-e72b-4e92-9195-7c1f349297f7.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eChronic cough in children: the etiology and medical history of 420 cases in Shanghai\u003c/p\u003e","fulltext":[{"header":"1. Background","content":" \u003cp\u003eChronic cough is one of common and frequently-occurring diseases in children. It refers to those who cough for more than 4 weeks [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], cough is the main or only clinical manifestation, and chest film shows no obvious abnormality. According to the nature of cough, it can be divided into dry cough and wet cough.\u003c/p\u003e \u003cp\u003eA long-term cough without definite diagnosis and repeated use of antibiotics will cause significant impairment to the quality of life, including children\u0026rsquo;s sleep, school attendance and play and parents\u0026rsquo; experience distress and anxiety [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, we studied the constituent ratio of various causes of chronic cough in children, analyzed and sorted out their medication history, in order to improve the diagnosis and treatment of non-specific chronic cough by pediatricians.\u003c/p\u003e "},{"header":"2. Materials And Methods","content":" \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study population\u003c/h2\u003e \u003cp\u003eThe survey was carried out in the Outpatient Department of five hospitals in different regions of Shanghai, including Longhua Hospital of Shanghai University of TCM, Pudong New District Hospital of TCM, Fengxian District Hospital of TCM, Jiading District Hospital of TCM, Shanghai Seventh People's Hospital.\u003c/p\u003e \u003cp\u003ePrior to the start of the project, training sessions on research plan and questionnaires will be held. After that, 420 children with chronic cough who met the diagnostic criteria were collected and analyzed statistically.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Selection criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria was:1) a cough of \u0026gt;\u0026thinsp;4 weeks duration; 2) cough is the main clinical manifestation; 3) aged 1\u0026ndash;14\u0026nbsp;years old; 4) there was no abnormalities in the chest X-ray film[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exclusion criteria was:1) children had abnormal chest X-ray; 2) had serious systemic diseases; and 3) unwilling/unable to cooperate with researchers to complete the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Survey development\u003c/h2\u003e \u003cp\u003eEach of the patients underwent the following procedures for the investigation of the cause of cough: 1) recording of medical history including symptoms and history of ear, nose, throat, respiratory tract, and digestive tract problems; 2) detailed physical examination with the targeted evaluation of throat congestion, follicular hyperplasia, and retropharyngeal postnasal drip; and 3) allergen test, chest X-ray examination, routine blood test, pulmonary function assessment and gastrointestinal dynamic ultrasound in patients with suspicious symptoms or signs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Methods\u003c/h2\u003e \u003cp\u003eThe diagnosis of the etiology of all children with non-specific chronic cough was referenced to the diagnosis and differential diagnosis of chronic cough in children guidelines[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEach of the patients underwent the following procedures for the investigation of the cause of cough: 1) detailed recording of medical history(duration and nature of the cough, associated symptoms, the history of medication, family history of allergic disease or related disease and information about the living environment of the patient); 2) detailed physical examination with particular attention to the heart and lower and upper airways; and 3) allergen test, routine blood test, chest X-ray examination, Pulmonary function assessment, gastrointestinal dynamic ultrasound in patients with suspicious symptoms or signs\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Analyses\u003c/h2\u003e \u003cp\u003eSPSS 24.0 was used to calculate the incidence rates of the clinical characteristics. The percentage of distribution of causes/medical history of each group was expressed by the percentage of ascertained causes/ medical history of each group to the total number of causes/ medical history of each group. The chisquare (\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e) test was used to evaluate the variable. Statistical significance was defined as a two-tailed P-value less than 0.05.\u003c/p\u003e \u003c/div\u003e "},{"header":"3. Results","content":" \u003cp\u003eThe General conditions: The 420 study subjects included 235 male (55.9%) and 185 female (44.1%) patients, with an average age of 5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u0026nbsp;years.\u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1. The etiological composition and cough character\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e showed etiological composition and cough character of chronic cough. The number of children between 1\u0026nbsp;years and 3\u0026nbsp;years was 48 (11.4%), the number of children between 3\u0026nbsp;years and 6\u0026nbsp;years was 227 (54.0%), and the number of children between 6\u0026nbsp;years and 14\u0026nbsp;years old was 145 (34.5%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of etiological composition and cough character of chronic cough in Children\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUACS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eGERD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u0026thinsp;~\u0026thinsp;3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e9(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e11.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e~\u0026thinsp;6\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86(37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e43(18.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45(19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e~\u0026thinsp;14\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43(29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36(24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e21(14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5(3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCough character\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eDry\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41(28.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e34(23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e25.948\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eWet\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110(39.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e72(26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e41(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e--\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e146(34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e90(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96(22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e75(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e11(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2(0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEtiological composition of chronic cough: PIC is the most common (34.8%) cause of chronic cough in children of 1\u0026ndash;14\u0026nbsp;years old, followed by UACS (22.9%), CVA (21.4%), AC (17.9%), TS (2.6%) and GERD (0.5%). Among these, in the young children (1\u0026ndash;3\u0026nbsp;years old), the sequence of the common cause of chronic cough was PIC (35.4%), UACS (25.0%), CVA (16.7%), AC (18.7%), GERC (2.1%) and TS (2.1%). In the preschool children (3\u0026ndash;6\u0026nbsp;years old), the sequence of the common cause of nonspecific chronic cough was PIC (37.9%), UACS (21.1%), AC (19.8%), CVA (18.9%), TS (2.2%) and GERD (0.0%). In the school-age children (6\u0026ndash;14\u0026nbsp;years old), the sequence of the common cause of nonspecific chronic cough was PIC (29.7%), CVA (26.9%), UACS (34.8%), AC (14.5%), TS (3.4%) and GERD (0.7%). There was no significant difference in etiological components among different ages (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn respect of cough character, 144 children (34.3%) were dry cough, and 276 children (65.7%) were wet cough. The common causes of wet cough were PIC (39.9%), UACS (26.1%), CVA (17.8%), AC (14.9%), TS (1.1%) and GERD (0.4%).The common causes of dry cough were CVA (28.5%), PIC (25.0%), AC (23.6%), UACS (16.7%), TS (5.6%) and GERD (0.7%).There was a significant difference in the cause of dry cough and wet cough (P༜0.001) .\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2. The attack time and associated symptoms\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed attack time and associated symptoms of chronic cough. The clinical manifestations of the patients in the PIC group included nasal congestion and runny nose. The patients in the CVA group presented with cough at night,in the morning, after exercise as the most characteristic feature. The clinical signs of the patients in the UACS group included cough in the morning, at night, nasal congestion, runny nose and sneezing. The patients in the AC group typically exhibited cough in the morning, in the evening and itchy throat. The characteristics of TS cough group were cough in daytime and disappear after sleep, accompanied by throat itching and throat clearing. The patients in the GERD group showed typical acid regurgitation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe attack time and associated symptoms of children with nonspecific chronic cough\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePIC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eUACS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGERD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttack time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003emorning\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91(62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62(64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40(53.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eafternoon\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6(54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eevening\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76(52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73(81.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11(14.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAfter exercise\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39(43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(13.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33(44.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAssociated Symptoms\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003enasal congestion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87(59.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73(76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13(17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003erunny nose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75(51.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61(63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003esneezing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63(65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eitchy throat\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57(39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28(29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67(89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7(63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003efeeling of mucus attachment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(19.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45(46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27(36.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSnoring\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(13.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4(36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003esour regurgitation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2(100.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003esigh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2(18.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003emolar\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0(0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.3. The medication history\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed the medication history of children with chronic cough. 281 children (67.1%)had a history of using Antimicrobial, 158 children (37.6%) had a history of using cough medication, 191 children (45.5%) had a history of using antihistamine, 136 children (32.4%) had a history of using Montelukast, 120 children (28.6%) had a history of using atomization inhalation preparation and 60 children (14.3%) had a history of using nasal spray.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe medication history of children with nonspecific chronic cough (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal sample n(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHave medication history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e371(88.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntimicrobials\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehad used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281(67.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAzitromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175(41.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClarithromycin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePenicillin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst-generation cephalosporin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond-generation cephalosporin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94(22.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird-generation cephalosporin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56(13.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough Medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ehave used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158(37.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcaterol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133(31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApophlegmatisant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(7.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAntihistamine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191(45.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMontelukast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136(32.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInhalation preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120(28.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNasal spray\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChinese patent drug\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185(44.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eChinese herbal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264(62.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong Antimicrobials, 175 children (41.7%) had a history of using azithromycin, 13 children (3.1%) had a history of using clarithromycin. 5 children (1.2%) had a history of using penicillin. 154 children (36.7%) had a history of using β-lactam antibiotics.\u003c/p\u003e \u003cp\u003eAmong cough medications, 133 children (31.7%) had a history of using Procaterol and 32 children (7.6%) had a history of using apophlegmatisant.\u003c/p\u003e \u003cp\u003eAmong atomization inhalation preparation, 120 children (28.5%) had a history of using terbutaline combined with budesonide, 2 children had a history of using Seretide.\u003c/p\u003e \u003cp\u003e185 children (44.1%) had a history of using Chinese patent drug. 264 children (62.9%) had a history of using Chinese herbal medicine.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.4. The past medical history, allergic history, family medical history and living environment\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e showed the past medical history, allergic history, family medical history and living environment of children with nonspecific chronic cough. 273 children (65.0%) had past medical history, including 133 cases of eczema history (31.7%), 139 cases of rhinitis history (33.1%), 38 cases of adenoid vegetation history (9.0%), 33 cases of pneumonia history (7.8%), 13 cases of anaemia history (3.1%), 5 cases of gastritis history (1.2%) and 3 cases of obesity history (0.7%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe past medical history, allergic history, family medical history and living environment of children with chronic cough (n\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal sample n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast medical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eeczema\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133(31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erhinitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139(33.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eadenoid vegetation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(9.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33(7.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eanaemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13(3.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egastritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eobesity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAllergic history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003edust mites\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eegg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(4.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emilk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(4.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eseafood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enut\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(1.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epollen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebeef/mutton\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eanimal hairs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(0.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily medical history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003erhinitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68(16.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003easthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(3.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epassive smoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133(31.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecultivate plants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134(31.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ekeep pets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(5.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ealong the street\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105(25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e63 children (15.0%) had allergic history, including 21 dust mites-allergic children (5.0%), 20 egg-allergic children (4.8%), 18 milk-allergic children (4.3%), 7 seafood-allergic children (1.7%), 7 nut-allergic children (1.7%), 3 pollen-allergic children (0.7%), 3 beef/mutton-allergic children (0.7%), 3 animal hairs-allergic children (0.7%) and 6 allergy to other substances (1.4%, 2 mango-allergic children, 1 chocolate-allergic child, 1 chicken-allergic child, 1 mycete-allergic child, 1 Penicillin-allergic child).\u003c/p\u003e \u003cp\u003e84 cases (20.0%) had family medical history, including 68 cases of family rhinitis history (16.2%), 16 cases of family asthma history (3.8%).\u003c/p\u003e \u003cp\u003e133 children\u0026rsquo;s family (31.7%) had smokers among the surrounding.134 families (31.9%) grew plants. 22 families (5.2%) kept pets.105 children\u0026rsquo;s (25.0%) home was along the street.\u003c/p\u003e \u003c/div\u003e "},{"header":"4. Discussion","content":" \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1. The etiology of chronic cough\u003c/h2\u003e \u003cp\u003eIn 2009, the top 3 causes of chronic cough were GERC, asthma, asthma-like diseases and AC in children of the United States [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In 2012, the \u0026ldquo;Prospective multicenter clinical study on the etiology component ratio of chronic cough in Chinese children\u0026rdquo; revealed that [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] the sequence of top 3 causes of chronic cough were CVA, UACS and PIC in Chinese children. What\u0026rsquo;s more, PIC was the most common cause in children under 6\u0026nbsp;years old. Kantar Ahmad [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] et al suggested chronic cough in preschool children is caused by protracted bacterial bronchitis (PBB), tracheobronchomalacia, foreign body aspiration, PIC or some combination of the above in most cases in Europe. They and ACCP [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] recommend that when evaluating and managing children\u0026rsquo;s chronic cough, their age and the clinical settings should be taken into consideration. The present study found that PIC (34.8%) was the most common cause of chronic cough in children in Shanghai, and UACS (22.9%) and CVA (21.4%) ranked second and third in the composition ratio of etiology, respectively. In this study average age of children was 5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u0026nbsp;years (under 6\u0026nbsp;years old), which matched the result of the research in China in 2012. In analysis of the causes, the differences in the proportion of causes of disease may be related to the ethnic group, society environment, living habits and age structure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2. The medication history of children with chronic cough\u003c/h2\u003e \u003cp\u003eWe collected the medication history of children in the course. The present study shows most children (67.1%) had a history of using antimicrobials. Studies showed using appropriate antibiotics improves cough resolution, especially for the chronic wet cough [\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e175 children (41.7%) had taken Azitromycin in the course. Mycoplasma pneumoniae is extensively regarded as major cause for CVA in clinics [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Hodgson David [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] et al found that Antimicrobial may have a place in the treatment of chronic cough associated with asthma. Martin Matthew J [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] et al found that those chronic cough patients, who were similar to the pediatric condition protracted bacterial bronchitis, had a good symptoms' response to low-dose azithromycin. What\u0026rsquo;s more, Azithromycin has a well-described anti-inflammatory properties which can be attributed to the interactions with cPLA₂, causing inadequate translocation of the enzyme or disturbing physical interactions with its substrates[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]; or attributed to the inhibition of the STAT1 and NF-κB signaling pathways through the drug's effect on p65 nuclear translocation and IKKβ[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Thus, Many pediatrician chose azithromycin to treat chronic cough.\u003c/p\u003e \u003cp\u003e206 children (49.0%) had a history of using cough medications. 136 children (32.4%) had a history of using Montelukast. Miwa Nanako [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] et al found that leukotriene receptor antagonist (LTRA) was useful in improving cough in patients with CVA. Tamaoki Jun [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] et al found that LTRA was more effective than the salmeterol in the treatment of CVA. Whereas it was not effective in non-productive cough in AC[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e185 children (44.1%) had taken Chinese patent drug. This showed that Chinese pediatrician prefer to use Chinese patent drug to relieve cough symptoms. 62.9% children had taken Chinese herbal medicine. There was a great variety of Chinese patent drug, and Chinese herbal medicine were mostly compound. Although they had certain curative effect in clinic, the mechanism was not clear.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3. The living environment of children with chronic cough\u003c/h2\u003e \u003cp\u003eWe found 133 children\u0026rsquo;s family (31.7%) had smokers among the surrounding. \u0026Ccedil;olak Yunus[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] et al found that smoking is one of the chronic cough risk factors. The prevalence of chronic cough in the current smokers was 8%. Johannessen Ane[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] et al believed that exposure to environmental tobacco smoke (ETS) is associated with impaired lung function in childhood. ETS might be one of the chronic cough risk factor.\u003c/p\u003e \u003cp\u003e105 children\u0026rsquo;s (25.0%) home were along the street. Fang Zhangfu[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] et al found that the traffic-related air pollution (TRAP) exposures induced cough hypersensitivity and non-allergic eosinophilic inflammation of airways in guinea-pigs. De Sajal [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] et al found that shopkeepers working in heavily trafficked roadside shops suffer from respiratory morbidity and the risk increases with higher total exposure period. We believe TRAP might be one of the chronic cough risk factor; this is worthy of further investigation.\u003c/p\u003e \u003c/div\u003e "},{"header":"5. Conclusion","content":" \u003cp\u003eAmong children aged 1\u0026ndash;14, the leading 3 causes of chronic cough in Shanghai were PIC, UACS and CVA. The mainly age of onset is 3\u0026ndash;6\u0026nbsp;years. The mainly cough character is wet cough.\u003c/p\u003e \u003cp\u003eBy collecting the medical history of children in the course, we found antibiotics are the mainly treatment, often combined with cough medicine and atomization. Azithromycin is the most commonly used antibiotic. More than half of the children used to seek traditional Chinese medicine treatment.\u003c/p\u003e "},{"header":"Abbreviations","content":" \u003cp\u003eAC, allergic (atopic) cough; CC, chronic cough ; CVA, cough variant asthma; GERC, gastroesophageal reflux cough; PIC, post-infection cough; TS, tourette cough; UACS, upper airway cough syndrome.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge nursing staff of Pediatric Unit for their assistance in the care of the patient and her family. We thank all the families that were involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u003c/strong\u003e Yonghong Jiang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData curation:\u003c/strong\u003e Yiliu Chen, Shuqin Wang, Chengxu Zhang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u003c/strong\u003e Yiliu Chen, Shuqin Wang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition: \u003c/strong\u003eYonghong Jiang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInvestigation\u003c/strong\u003e: Yonghong Jiang, Zhiyan Jiang, Zhoujian Yang, Junxia Li, Liming Mao, Jingwen Gu, Yiliu Chen, Shuqin Wang, Chengxu Zhang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: Yonghong Jiang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProject administration\u003c/strong\u003e: Yonghong Jiang, Zhen Xiao.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupervision:\u003c/strong\u003e Yonghong Jiang, Zhen Xiao.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting:\u003c/strong\u003e Yiliu Chen, Yonghong Jiang.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShanghai Shenkang, Grant/Award Number: 16CR4032A\u003c/p\u003e\n\u003cp\u003eShanghai Municipal Key Clinical Specialty, Grant/Award Number: shslczdzk04102\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained after detailed explanation of the study aim from the patient\u0026rsquo;s parents. Parents could withdraw consent in any moment during the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no financial relationships related to this work to disclose. The authors declare that there are no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e \u003cspan\u003eChang AB, GlombWB. Guidelines for evaluating chronic cough in pediatric: ACCP evidence-based clinical practice. guidelines JChest. 2006;129(1):260\u0026ndash;83.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eCornford CS, Morgan M, Ridsdale L. Why do mothers consult when their children cough? Fam Pract. 1993;10:193\u0026ndash;6.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eTraisman Edward S. Clinical Evaluation of Chronic Cough in Children.J. Pediatr Ann. 2015;44:303\u0026ndash;7.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eNewcombe Peter A, Sheffield Jeanie K, Petsky Helen L, et al. A child chronic cough-specific quality of life measure: development and validation. JThorax. 2016;71:695\u0026ndash;700.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKurlan R. Handbook of Tourette's syndrome and related tic and behavioral disorders [M]. 2nded. New York: Maecel Dekker; 2005. pp.\u0026nbsp;155\u0026ndash;71.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eBao YX, Chen AH, FU Z, et al. The Subspecialty Group of Respiratory Diseases, The Society of Pediatrics, Chinese Medical Association,editoral board of chinese journal of pediatricsGuide for diagnosis, prevention and treatment of san bronchial asthma in pediatrics. Chinese J Pediatr. 2016;54:167\u0026ndash;81.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eGedik AH, Cakir E, Torun E, et al. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr. 2015;41:73.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKhoshoo V, Edell D, Mohnot S, et al. Associated factors in children with chronic cough. Chest. 2009;136(3):811\u0026ndash;5.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eYuan D, Tang SP, Chen Q, et al. Clinical Research Coordination Group of the Causes Constituents Ratio of Chronic Cough in Chinese Children Prospective multicenter clinical study on the causes constituents ratio of chronic cough in Chinese children. Zhonghua Er Ke Za Zhi. 2012;50:83\u0026ndash;92.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eKantar Ahmad B, Roberto P, Francesco, et al. Chronic cough in preschool children. J..Early Hum. Dev., 2013, null: S19-24.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eChang Anne B, Oppenheimer John J, Weinberger, Miles, et al. Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report. JChest. 2017;152:607\u0026ndash;17.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eWong O, Yin M, Julie M, Yerkovich Stephanie T, et al. Predictors of time to cough resolution in children with chronic wet cough treated with antibiotics after bronchoscopy. JPediatr Pulmonol. 2019;54:1997\u0026ndash;2002.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eChang Anne B, Oppenheimer John J, Weinberger Miles M, et al. Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. JChest. 2017;151:884\u0026ndash;90.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eChang Anne B, Oppenheimer John J, Weinberger, Miles, et al. Children With Chronic Wet or Productive Cough\u0026ndash;Treatment and Investigations. A Systematic ReviewJChest. 2016;149:120\u0026ndash;42.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eMarchant Julie M, Petsky Helen L, Morris Peter S, et al. Antibiotics for prolonged wet cough in children. JCochrane Database Syst Rev. 2018;7:CD004822.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eLi Wen B, Cunfang Z. Junxia et al. Correlation study of cough variant asthma and mycoplasma pneumonia infection in children.J. Pak J Pharm Sci. 2017;30:1099\u0026ndash;102.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eCatherine HDavid,AJohn,R, et al. The Effects of Azithromycin in Treatment-Resistant Cough: A Randomized, Double-Blind. Placebo-Controlled TrialJChest. 2016;149:1052\u0026ndash;60.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eMartin Matthew J, Lee Helen C, Carly, et al. 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Association of exposure to environmental tobacco smoke in childhood with chronic obstructive pulmonary disease and respiratory symptoms in adults. JRespirology. 2012;17:499\u0026ndash;505.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eFang Zhangfu H, Chuqin ZJ, Jim, et al. Traffic-related air pollution induces non-allergic eosinophilic airway inflammation and cough hypersensitivity in guinea-pigs.J. Clin Exp Allergy. 2019;49:366\u0026ndash;77.\u003c/span\u003e \u003c/li\u003e \u003cli\u003e \u003cspan\u003eDe Sajal KGaganD, Singh D, Dharmendra, et al. Respiratory Morbidity of Roadside Shopkeepers Exposed to Traffic-related Air Pollution in Bhopal, India. JJ Health Pollut. 2019;9:190305.\u003c/span\u003e \u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"chronic cough, children, etiology, medication history, Shanghai","lastPublishedDoi":"10.21203/rs.3.rs-64375/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-64375/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eChronic cough is one of the most common and frequently-occurring diseases in children. We investigated the etiologies and clinical features of children with chronic cough (CC), in order to improve the diagnostic and treatment of the disease by pediatricians.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe clinical data of 420 cases of children, aged 1\u0026ndash;14\u0026nbsp;years old, from 5 hospitals\u0026rsquo; Outpatient Department in different regions of Shanghai, who suffered from chronic cough between the period of September 2017 and July 2019 were prospectively analyzed. Children with chronic cough were enrolled to identify the specific cause and clinical information based on a questionnaire survey. All the data were collected and statistically analyzed by Chi-square test to identify the constituent ratio of each cause.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe etiology component ratio showed that 146 cases (34.8%) had post-infection cough (PIC); 96 cases (22.9%) had upper airway cough syndrome (UACS); 90 cases (21.4%) had cough variant asthma (CVA); 75 cases (17.9%) had allergic (atopic) cough (AC); 11 cases (2.6%) had tourette cough (TS); 2 cases (0.5%) had gastroesophageal reflux cough (GERD). For the children with CC, the mainly age of onset is 3\u0026ndash;6\u0026nbsp;years (54.05%). The mainly cough character is wet cough (65.7%). 67.1% of children with chronic cough were prescribed antibiotics, of which 41.7% were azithromycin. Various cough drops, antihistamines, aerosolized inhalation, montelukast, etc. were often used in the treatment of children's chronic cough.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe leading 3 causes of chronic cough in children were PIC, UACS and CVA. The mainly age of onset is 3\u0026ndash;6 years; mainly cough character is wet cough. Antibiotics are the mainly treatment, often combined with cough medicine and atomization.\u003c/p\u003e","manuscriptTitle":"Chronic cough in children: the etiology and medical history of 420 cases in Shanghai","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-09-09 16:01:55","doi":"10.21203/rs.3.rs-64375/v1","editorialEvents":[{"type":"communityComments","content":1}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"97d8d8db-3085-469b-b748-9e11946c1890","owner":[],"postedDate":"September 9th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":466859,"name":"Parasitology"}],"tags":[],"updatedAt":"2020-10-04T15:28:32+00:00","versionOfRecord":[],"versionCreatedAt":"2020-09-09 16:01:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-64375","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-64375","identity":"rs-64375","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}