Longitudinal study of quality of life among children with acute respiratory infection and cough
Acute respiratory infections (ARIs), and associated symptoms such as cough, are frequently experienced among children and impose a burden on families (e.g., use of medical resources and time off work/school). However, there are little data on changes in, and predictors of, quality of life (QoL) over the duration of an ARI with cough (ARIwC) episode. We therefore aimed to determine cough-specific QoL and identify its influencing factors among children with ARIwC, at the time of presentation to a pediatric emergency department (ED), and over the following 4 weeks.
Data from 283 children aged < 15 years were included in our analyses. We used the validated parent-proxy children’s acute cough-specific QoL questionnaire (PAC-QoL) at each time-point. Linear regression and mixed effect modeling were used to identify factors influencing QoL at baseline and over the follow-up period.
Median PAC-QoL at baseline was 2.7 (IQR 2.1–3.6) and significantly improved by Day-7 (4.9, IQR 3.8–6.1) and Day-14 (6.59, IQR 5.1–7.0), both p < 0.001. The improvements in median PAC-QoL between Days-14, -21, and -28 were not significant. Regression modeling identified that day-cough severity, night-cough severity, and financial concerns had the highest impact on both baseline, and follow-up, PAC-QoL scores. There were five additional independent significant factors at baseline and six at follow-up.
Quality of life is considerably impaired at presentation to ED, but improves significantly by Days-7 and -14. As cough severity and financial concerns had the highest impact on QoL, effectively managing cough to reduce the clinical and financial burden on children and families is important.
KeywordsAcute respiratory infection Cough Parent-proxy quality of life Pediatrics Children Emergency department
The authors gratefully acknowledge the following people and departments for their assistance with this study: the RCH Emergency Department and Paediatric Emergency Research Unit; the Respiratory Physicians (particularly Prof Alan Isles, A/Prof Brent Masters, Dr Danielle Wurzel, Dr Vikas Goyal and Dr Nitin Kapur), Respiratory Scientists and administration staff at the Queensland Children’s Respiratory Centre; the Medical Records staff at the Royal Children’s Hospital and members of the Cough Asthma and Airways Research Group and Respiratory infection Outreach Research Teams, particularly Ben Arnold, Daniel Arnold, Simon Foster, Kate Shackleton, Clementine Shevill, and Jack Roberts.
Financial support for this study was received from a Queensland Children’s Health Foundation Program Grant awarded to ABC. YLT is funded by a QUT Research Training Program Stipend from the Queensland University of Technology and a top-up scholarship from the National Health and Medical Research Council’s Centre for Research Excellence in Lung Health (1040830). KFO was supported by a Queensland Government Smart Futures Fellowship (51008) and an Australian National Health and Medical Research Council (NHMRC) Career Development Award (1045157). ABC is supported by a NHMRC Practitioner Fellowship (1058213). BD was supported by a NHMRC Post-Graduate Scholarship (1075467) and a Queensland Children’s Medical Research Institute Top-Up Scholarship. SAJ was supported by an Equity Trustees postgraduate training scholarship and the Children’s Hospital Foundation through a program grant (50004) awarded to AC. The funding sources had no involvement in the study design; collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 5.Moore, H. C., De Klerk, N., Jacoby, P., Richmond, P., & Lehmann, D. (2012). Can linked emergency department data help assess the out-of-hospital burden of acute lower respiratory infections? A population-based cohort study. BMC Public Health, 12(1), 703–711. https://doi.org/10.1186/1471-2458-12-703.PubMedGoogle Scholar
- 6.Hardy, A., Fuller, D. G., Forrester, M., Anderson, K. P., Cooper, C., Jenner, B., et al. (2016). Per capita increase in hospital presentations and admissions among children since the 1990s. Journal of Paediatrics and Child Health, 52(10), 935–938. https://doi.org/10.1111/jpc.13232.PubMedGoogle Scholar
- 7.O’Grady, K. F., Grimwood, K., Sloots, T. P., Whiley, D. M., Acworth, J. P., Phillips, N., et al. (2016). Prevalence, codetection and seasonal distribution of upper airway viruses and bacteria in children with acute respiratory illnesses with cough as a symptom. Clinical Microbiology and Infection, 22(6), 527–534. https://doi.org/10.1016/j.cmi.2016.02.004.PubMedGoogle Scholar
- 10.Angoulvant, F., Jumel, S., Prot-Labarthe, S., Bellettre, X., Kahil, M., Smail, A., et al. (2013). Multiple health care visits related to a pediatric emergency visit for young children with common illnesses. European Journal of Pediatrics, 172(6), 797–802. https://doi.org/10.1007/s00431-013-1968-9.PubMedGoogle Scholar
- 11.Britt, H., Miller, G. C., Henderson, J., Bayram, C., Harrison, C., Valenti, L., Wong, C., Gordon, J., Pollack, A. J., Pan, Y., Charles, J. (2015). General practice activity in Australia 2014–15. General practice series no. 38. Sydney: Sydney University Press. Retrieved from http://hdl.handle.net/2123/13765.
- 12.Petsios, K. T., Priftis, K. N., Tsoumakas, C., Perperoglou, A., Hatziagorou, E., Tsanakas, J. N., et al. (2009). Cough affects quality of life in asthmatic children aged 8–14 more than other asthma symptoms. Allergologia et Immunopathologia, 37(2), 80–88. https://doi.org/10.1016/s0301-0546(09)71109-7.PubMedGoogle Scholar
- 14.Chow, M. Y. K., Morrow, A. M., Robbins, S. C. C., & Leask, J. (2013). Condition-specific quality of life questionnaires for caregivers of children with pediatric conditions: A systematic review. Quality of Life Research, 22(8), 2183–2200. https://doi.org/10.1007/s11136-012-0343-z.PubMedGoogle Scholar
- 15.Anderson-James, S., Newcombe, P. A., Marchant, J. M., O’Grady, K. A. F., Acworth, J. P., Stone, D. G., et al. (2015). An acute cough-specific quality-of-life questionnaire for children: Development and validation. The Journal of Allergy and Clinical Immunology, 135(5), 1179–1185.e4. https://doi.org/10.1016/j.jaci.2014.08.036.PubMedGoogle Scholar
- 17.Shoham, Y., Dagan, R., Givon-Lavi, N., Liss, Z., Shagan, T., Zamir, O., et al. (2005). Community-acquired pneumonia in children: Quantifying the burden on patients and their families including decrease in quality of life. Pediatrics, 115(5), 1213–1219. https://doi.org/10.1542/peds.2004-1285.PubMedGoogle Scholar
- 22.Jensen, M. E., Mendelson, M. J., Desplats, E., Zhang, X., Platt, R., & Ducharme, F. M. (2016). Caregiver’s functional status during a young child’s asthma exacerbation: A validated instrument. The Journal of Allergy and Clinical Immunology, 137(3), 782–788.e6. https://doi.org/10.1016/j.jaci.2015.08.031.PubMedGoogle Scholar
- 23.Drescher, B. J., Chang, A. B., Phillips, N., Acworth, J., Marchant, J., Sloots, T. P., et al. (2013). The development of chronic cough in children following presentation to a tertiary paediatric emergency department with acute respiratory illness: Study protocol for a prospective cohort study. BMC Pediatrics, 13(1), 125–133. https://doi.org/10.1186/1471-2431-13-125.PubMedGoogle Scholar
- 26.Chang, A. B., Newman, R. G., Carlin, J. B., Phelan, P. D., & Robertson, C. F. (1998). Subjective scoring of cough in children: Parent-completed vs child-completed diary cards vs an objective method. European Respiratory Journal, 11(2), 462–466. https://doi.org/10.1183/09031936.98.11020462.PubMedGoogle Scholar
- 28.Galecki, A. T., West, B. T., & Welch, K. B. (2006). Linear mixed models: A practical guide using statistical software. Philadelphia, PA: Chapman and Hall.Google Scholar
- 30.Australian Bureau of Statistics. (2016). Census of population and housing, quick stats Queensland—Level of highest educational attainment. 2017. Retrieved from http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/3?opendocument.
- 31.Australian Institute of Family Studies. (2013). Parents working out work (Australian Family Trends No. 1). Retrieved from http://www.aifs.gov.au/publications/parents-working-out-work.
- 32.Australian Bureau of Statistics. (2016). Census of population and housing, general community profile: Queensland, Table G28 total family income (weekly) by family composition—Couple family with children. 2017. Excel spreadsheet, cat. no. 2001.0. Retrieved from http://www.censusdata.abs.gov.au/CensusOutput/copsub2016.NSF/All%20docs%20by%20catNo/2016~Community%20Profile~3/$File/GCP_3.zip?OpenElement.
- 33.Australian Bureau of Statistics. (2016). Census of population and housing, general community profile: Queensland, G01 selected person characteristics by sex (1 of 2)—Males and females 0–14 years. 2017. Excel spreadsheet, cat. no. 2001.0. Retrieved from http://www.censusdata.abs.gov.au/CensusOutput/copsub2016.NSF/All%20docs%20by%20catNo/2016~Community%20Profile~3/$File/GCP_3.zip?OpenElement.
- 34.Australian Bureau of Statistics. (2012). Australian health survey. First results, 2011–12—Table 3.3 long-term conditions, proportion of persons, children aged 0–14 yrs. Excel spreadsheet, cat. no. 4364.0.55.001. Retrieved from http://www.abs.gov.au/ausstats/subscriber.nsf/log?openagent&43640do003_20112012v2.xls&4364.0.55.001&Data%20Cubes&C6D4971625F0E865CA257B820017A54F&0&2011-12&07.06.2013&Previous.
- 38.Bont, L., Steijn, M., van Aalderen, W. M. C., & Kimpen, J. L. L. (2004). Impact of wheezing after respiratory syncytial virus infection on health-related quality of life. The Pediatric Infectious Disease Journal, 23(5), 414–417. https://doi.org/10.1097/01.inf.0000122604.32137.29.PubMedGoogle Scholar
- 41.Mistry, R. D., Stevens, M. W., & Gorelick, M. H. (2009). Health-related quality of life for pediatric emergency department febrile illnesses: An evaluation of the pediatric quality of life inventory 4.0 generic core scales. Health and Quality of Life Outcomes, 7(1), 5–13. https://doi.org/10.1186/1477-7525-7-5.PubMedGoogle Scholar