Chronic Cough: A neglected area in pediatric clinical practice

Objective: Cough is one of the most common but usually neglected complaint in pediatric clinical practice. We aimed to explore the knowledge, attitude and clinical practice among general pediatricians on chronic cough management. Methods: Data were prepared as questionnaires that had been developed by cough guidelines in the literature. Results: Among 109 general pediatricians, a total of 88 (80,7%) participated into the study; 43.2 % were female and the mean age was 42.01±7.89 yrs. The response for the definition of chronic cough ranged from 2 weeks to 6 months. Of the participants, 45.4% stated that they frequently evaluated children with chronic cough. The majority (79.5%) sought consultation from one to four discrete specialties. The most frequently ordered two tests were chest radiography (88.6%) and complete blood count (30.7%). The majority of pediatricians prescribed antibiotics (95.5%), antitussives (67.0%), expectorants (77.3%), anti-histamines (62.5%) and empiric anti-reflux medications (69.3%) to children with chronic cough. Most commonly prescribed antibiotic was macrolides (95.5%). Among pediatricians, only 12.5% questioned passive smoking exposure and rarely advised professional counseling against smoking to parents (55.6%).Overall, 66.0% of pediatricians agreed that they did not feel fully satisfied in the management of chronic cough in children. All supported the preparation of a national guideline and were willing for postgraduate education on chronic cough management. Conclusions: This study emphasizes the pediatricians’ lack of knowledge on chronic cough management in children. Education is crucially important on chronic cough management among general pediatricians which possibly decrease the differences in personal practice.

Kronik Öksürük: Çocuk Hastalıkları Klinik Pratiğinde İhmal Edilen Alan

Giriş: Çocuk hastalıkları pratiğinde öksürük en sık ve aynı zamanda en az irdelenen şikayettir. Çalışmamızda, kronik öksürük yönetimi hakkında genel pediatristlerin bilgi, tavır ve klinik yaklaşımlarını araştırmayı amaçladık. Yöntemler: Veri bilgileri literatürde öksürük rehberlerinden geliştirilen anket ile sağlanmıştır. Bulgular: Çalışmamıza Mersin bölgemizde 109 genel pediatri hekiminden 88’i (%80,7) katılmış, bunlardan %43,2’si kadın ve yaş ortalaması 42.01±7.89 yıldır. Kronik öksürüğün tanımına verilen yanıtlar 2 hafta ile 6 ay arasında değişkenlik göstermiştir. Çalışmaya katılanların %45,4 kronik öksürük şikayeti olan çocuklarla sık karşılaştıklarını belirtmişlerdir. Çoğunlukla (%79,5) 1 ile 4 arası diğer branşlardan (çocuk allerji, çocuk göğüs hastalıkları ve çocuk gastroenteroloji) konsültasyon ile yardım talep edilmiştir. En sık istenen testler akciğer radyografisi (%88,6) ve tam kan sayımıdır (%30,7). Kronik öksürük tedavisinde çocuk hekimlerinin çoğunluğu sıklıkla antibiyotikler (%95,5), öksürük kesiciler (%67,0), ekspektoranlar (%77,3), antihistaminikler (%62,5) ve ampirik antireflü (%69,3) tedavisi önermişlerdir. En sık yazılan antibiyotik makrolidlerdir (%95,5). Pasif sigara maruziyetini sadece %12,5 çocuk hekimi sorgulamış ve sigara içen ebeveynlere nadiren profesyonel yardım almaları önerisinde bulunmuştur (%55,4). Çocuk hekimlerinin çoğunluğu (%66,0) kronik öksürük yönetiminde yeterli olmadıklarını düşünmüşlerdir. Tüm hekimler kronik öksürükle ilgili ulusal rehbere ihtiyaç olduğunu ve bu konuda mezuniyet sonrası eğitime katılmak istediklerini belirtmişlerdir. Sonuçlar:Çalışmamıza katılan çocuk hekimlerinin kronik öksürük yönetimi ile ilgili bilgi eksiklikleri vurgulanmışlardır. Genel çocuk hekimliğinde kişisel klinik farklılıkları azaltmak için kronik öksürük yönetimi eğitimi gereklidir.

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