The natural history of acute cough in pre-school children in primary care

This thesis, of the natural history of acute cough in pre-school children, reports two studies: a systematic review and a prospective cohort study. The systematic review includes data synthesised from eight randomised controlled trials (RCTs) of antibiotics. The patients included in these RCTs appear to be an unrepresentative, selected population. The studies in the review also used different measures and definitions of cough duration, making it difficult to estimate the usual duration of the illness. Therefore, the cohort study determines the prognostic implications of the symptom cough in terms of cough duration, reconsultations and complications in an unselected cohort of pre-school children presenting to primary care. Aims of the thesis: 1. To describe cough duration in terms of the different proportion of children recovering through time. 2. To compare parent and clinician expectation of cough duration with actual cough duration. 3. To identify the clinical factors associated with prolonged cough. 4. To describe reconstruction and antibiotic prescribing rates ad the factors associated with reconstructions. 5. To document the complication rate and derive a clinical prediction rule for complications. 6. To examine the inter-observer agreement between an unstandardised and standardised clinical assessment. Chapter 2 is divided into two parts. First, the general literature review I describe the physiology, aetiology, classification and epidemiology of cough, I review the reasons for parental consultation and the management of cough in primary care, I discuss the development of clinical prediction rates, and their potential role in the management of cough and I present an overview of outcome measures for respiratory tract infections in pre-school children. Second, in the systematic review and meta-analysis, I present the evidence to date regarding the natural history of cough in pre-school children.