La plainte de toux prolongée chez l'enfant en première ligne de soins
(2011)
Files
20octobre.pdf
Restricted Access - Adobe PDF
- 3.09 MB
Details
- Authors
- Supervisors
- Degryse, Jean-Marie
- Abstract
- (en) Prolonged cough in children is a common problem in the population, and one with which general practitioners are regularly confronted. This complaint causes great anxiety for parents, who fear that the child may become unable to breathe or may suffer irreversible lung damage. What care should be offered and how should assessment be performed by the doctor faced with this complaint? A literature review regarding studies conducted on children provides little evidence of the best way to manage this complaint. Characteristics of the cough, such as its frequency and whether it is thick or dry, have not been proven to have significance. Similarly, there is no proven benefit to ordering additional systematic tests, which must be chosen in accordance with clinical suspicions. A model of care was developed and discussed in group training. Similarly, with regard to cough treatment, cough suppressants are widely used despite the lack of evidence of their superior efficacy to placebo, although they are no doubt effective. Placing the patient at the center of care and considering his doubts, fears, expectations, and beliefs regarding the diagnosis or treatment is a cornerstone of care and could help to limit unnecessary treatment. First line case studies show us some problems of research in general practice and suggest a favorable trend for many of these prolonged cough cases, and this study encourages us to give equal consideration to environmental causes. Regarding the assessment of the importance of coughs, the practitioner has tools that can measure the impact of a cough on quality of life, which is probably the single most important measure in the case of relieving a cough that has no indications of potentially serious effects. Despite the research in this area, which has been developed over several decades, there is currently no tool for measuring the frequency and intensity of cough, allowing a reliable and valid measure of cough for ambulatory patients, with fully automated analysis of results. Measurement tools produce many false positives. For example, the LR102, which we have tested, showed good correlation with measurements made by video counting, but overestimates the number of coughs. Better identification of false positives is still needed as well as the development of a fully automated system for counting instances of coughing. What would be the place of such tools? They could provide a quantitative measure of the development of the cough in large scale clinical trials or for a particular patient. They would objectify the response to therapeutic trials, for example with antacids. These methods for assessing coughs open the field to further research, such as to whether the frequency or severity of coughs are related to the etiological severity of the disease. The methods could, in this case, be used to monitor the severity of the disease. The question of whether certain patterns are predictive of certain causes of cough could also be investigated.
- Affiliations
Citations
Leconte, S. (2011). La plainte de toux prolongée chez l’enfant en première ligne de soins. https://hdl.handle.net/2078.5/157832