Purpose of the Study. To evaluate sputum eosinophils in children with wheeze versus cough versus chest colds.
Study Population. A total of 83 children 8 to 11 years old recruited form primary schools in Australia based on a questionnaire regarding respiratory symptoms. Four groups: wheezed more than twice in last 12 months with or without colds (n = 28), night cough (but no wheeze) for at least 2 weeks in the last 12 months without colds (n = 12), chest colds (cough, but no wheeze) more than twice in last 12 months (n = 27) and control (no cough or wheeze) (n = 26).
Methods. Sputum induction.
Results. Median sputum eosinophil percentages were higher for children with wheeze (3.1%) than for children with cough (0.5%), chest colds (0%) or controls (0%) (P = .03). The percentage in each group with “eosinophilic bronchitis” (defined as sputum eosinophilia >2.5%) was 45%, 20%, 15% and 9.4%, respectively.
Conclusion. The authors conclude that “wheeze is a good discriminator for the presence of eosinophilic bronchitis, and that persistent cough and recurrent chest colds without wheeze should not be considered a variant of asthma.”
Reviewer’s Comments. It is interesting to note the greater likelihood of finding sputum eosinophilia with wheeze as opposed to cough, however, I think it would be a mistake to dismiss the idea that chronic or recurrent cough, with or without viral respiratory infections, can be the sole manifestation of asthma. Sputum eosinophilia on a single induced sputum sample would not seem to be a gold standard for the diagnosis of asthma as fewer than half of those with recurrent wheeze had “eosinophilic bronchitis” and 15% to 20% of those with “variant asthma” did. Although other causes of chronic cough, such as tobacco exposure should be evaluated as the authors suggest, I believe a trial of asthma medication is often warranted in such children.
- Copyright © 2002 by the American Academy of Pediatrics