The Healthcare Burden of Pediatric Cough and Associations With Preschool Asthma – Findings from the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study

Abstract Rationale: Asthma is the most common chronic airway disease among preschool-aged children and carries a high healthcare burden in terms of unplanned healthcare visits, medication-use and lower health-related quality of life. Although cough is a clinically relevant symptom of childhood asthma, current prediction tools focus on wheeze as its primary indicator, and there is conflicting literature regarding the healthcare burden of cough. We evaluated the association between cough features and asthma, and its healthcare burden among Canadian preschool-aged children with/without coexisting wheeze. Methods: Data from the CHILD Cohort Study, a prospective, longitudinal general-population Canadian birth cohort study was used. Information on presence, duration, severity, and frequency of cough without cold, wheeze, unscheduled doctor visits (UDVs), hospital visits (HVs) and use of bronchodilators (BD), inhaled corticosteroids (ICS), and oral corticosteroids (OCS) in the first 5-years of life were obtained via parent-reported questionnaires and in-person clinical assessments. Longitudinal associations between cough and healthcare/medication-use outcomes were estimated via repeated measures generalized estimation equations, using data collected during infancy (birth to 12-months) and preschool (>12months to 5-years). Models were adjusted for breastfeeding duration, sex, smoke exposure, maternal asthma, study site, family income and preschool asthma diagnosis. Results: Of 3,042 participants during the infancy period, 324 (10.6%) had cough without cold, and 737 (24.2%) had wheeze. Of 2,822 participants during preschool visits, 288 (10.2%) had cough and 703 (24.9%) had wheeze. In infancy, cough was significantly associated with increased UDVs, HVs, and OCS-use. Compared to cough, infants with wheeze had stronger association with UDVs, HVs, ICS and BD-use. Notably, both cough [adjusted odds ratio: 1.39 (95% confidence interval: 1.01 – 1.93)] and wheeze [1.45 (1.14 – 1.84)] were associated with OCS-use. Moreover, infants with cough ≥4 days were 74% more likely to require UDVs, and those with moderate-severe cough (i.e. cough disturbs daily activities/sleep) were at least twice as likely to require UDVs, HVs and OCS-use (Table). In preschool, odds of UDVs, HVs, ICS and BD were increased in children with cough and further increased in those with wheeze. Nonetheless, preschoolers exhibiting cough ≥4 days, or moderate-severe cough were significantly associated with increased UDVs, HVs, ICS-use and BD-use independent of wheeze (Table). Conclusions: Cough without cold, even in the absence of wheeze, carries a high healthcare utilization burden from infancy throughout preschool, and its relationship to asthma medication-use demonstrates a need to re-evaluate treatment plans among non-wheezing children with cough ≥4 days or moderate-severe cough.

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