Quality of Life Research

, Volume 27, Issue 4, pp 891–903 | Cite as

Longitudinal study of quality of life among children with acute respiratory infection and cough

  • Yolanda G. Lovie-Toon
  • Anne B. Chang
  • Peter A. Newcombe
  • Dimitrios Vagenas
  • Sophie Anderson-James
  • Benjamin J. Drescher
  • Michael E. Otim
  • Kerry-Ann F. O’Grady



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.


Acute 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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

Supplementary material

11136_2017_1779_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 KB)


  1. 1.
    Chang, A. B., Landau, L. I., Van Asperen, P. P., Glasgow, N. J., Robertson, C. F., Marchant, J. M., et al. (2006). Cough in children: Definitions and clinical evaluation. The Medical Journal of Australia, 184(8), 398–403.PubMedGoogle Scholar
  2. 2.
    Gazzaz, Z. J., Dhafar, K. O., Maimini, O., Farooq, M. U., & Ahmad, I. (2012). Audit of an urban paediatric emergency department visits. Nigerian Medical Journal, 53(3), 129–131.  https://doi.org/10.4103/0300-1652.104380.PubMedGoogle Scholar
  3. 3.
    Pandee, U., Vallipakorn, S. A., & Plitponkarnpim, A. (2015). The profile of pediatric patients visit emergency department at urban University Hospital in Thailand. Journal of the Medical Association of Thailand, 98(8), 761–767.PubMedGoogle Scholar
  4. 4.
    Yaprak, S., Bulut, U., Okudan, Y. E., Gokdemir, O., Colak, M., Yildirim, E., et al. (2016). Caregiver reasons for tertiary health-care seeking for children aged ≤ 12 years. Pediatrics International, 58(10), 1037–1041.  https://doi.org/10.1111/ped.12930.PubMedGoogle Scholar
  5. 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. 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. 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
  8. 8.
    Marchant, J. M., Newcombe, P. A., Juniper, E. F., Sheffield, J. K., Stathis, S. L., & Chang, A. B. (2008). What is the burden of chronic cough for families? Chest, 134(2), 303–309.  https://doi.org/10.1378/chest.07-2236.PubMedGoogle Scholar
  9. 9.
    Hollinghurst, S., Gorst, C., Fahey, T., & Hay, A. D. (2008). Measuring the financial burden of acute cough in pre-school children: A cost of illness study. BMC Family Practice, 9(1), 10–16.  https://doi.org/10.1186/1471-2296-9-10.PubMedGoogle Scholar
  10. 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. 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. 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
  13. 13.
    Chang, A. B., Robertson, C. F., Van Asperen, P. P., Glasgow, N. J., Mellis, C. M., Masters, I. B., et al. (2012). A multicenter study on chronic cough in children. Chest, 142(4), 943–950.  https://doi.org/10.1378/chest.11-2725.PubMedGoogle Scholar
  14. 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. 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
  16. 16.
    Newcombe, P. A., Sheffield, J. K., & Chang, A. B. (2013). Parent cough-specific quality of life: Development and validation of a short form. The Journal of Allergy and Clinical Immunology, 131(4), 1069–1074.  https://doi.org/10.1016/j.jaci.2012.10.004.PubMedGoogle Scholar
  17. 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
  18. 18.
    Chow, M. Y. K., Yin, J. K., Heron, L., Morrow, A., Dierig, A., Booy, R., et al. (2014). The impact of influenza-like illness in young children on their parents: A quality of life survey. Quality of Life Research, 23(5), 1651–1660.  https://doi.org/10.1007/s11136-013-0606-3.PubMedGoogle Scholar
  19. 19.
    Jiang, X., Sun, L., Wang, B., Yang, X., Shang, L., & Zhang, Y. (2013). Health-related quality of life among children with recurrent respiratory tract infections in Xi’an, China. PLoS ONE, 8(2), e56945. doi. https://doi.org/10.1371/journal.pone.0056945.PubMedGoogle Scholar
  20. 20.
    Oostenbrink, R., Jansingh-Piepers, E. M., Raat, H., Nuijsink, M., Landgraf, J. M., Essink-Bot, M. L., et al. (2006). Health-related quality of life of pre-school children with wheezing illness. Pediatric Pulmonology, 41(10), 993–1000.  https://doi.org/10.1002/ppul.20486.PubMedGoogle Scholar
  21. 21.
    Chow, M. Y. K., Morrow, A., Heron, L., Yin, J. K., Booy, R., & Leask, J. (2014). Quality of life for parents of children with influenza-like illness: Development and validation of Care-ILI-QoL. Quality of Life Research, 23(3), 939–951.  https://doi.org/10.1007/s11136-013-0538-y.PubMedGoogle Scholar
  22. 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. 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
  24. 24.
    Marchant, J. M., Masters, I. B., Taylor, S. M., et al. (2006). Evaluation and outcome of young children with chronic cough. Chest, 129(5), 1132–1141.  https://doi.org/10.1378/chest.129.5.1132.PubMedGoogle Scholar
  25. 25.
    Chang, A. B., Robertson, C. F., van Asperen, P. P., et al. (2013). A cough algorithm for chronic cough in children: A multicenter, randomized controlled study. Pediatrics, 131(5), e1576–e1583. doi. https://doi.org/10.1542/peds.2012-3318.PubMedGoogle Scholar
  26. 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
  27. 27.
    De Livera, A. M., Zaloumis, S., & Simpson, J. A. (2014). Models for the analysis of repeated continuous outcome measures in clinical trials. Respirology, 19(2), 155–161.  https://doi.org/10.1111/resp.12217.PubMedGoogle Scholar
  28. 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
  29. 29.
    Zuur, A., Ieno, E. N., & Walker, N. (2009). Statistics for biology and health: Mixed effects models and extensions in ecology with R. New York: Springer.CrossRefGoogle Scholar
  30. 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. 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. 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/$File/GCP_3.zip?OpenElement.
  33. 33.
    Australian Bureau of Statistics. (2016). Census of population and housing, general community profile: Queensland, G01 selected person characteristics by sex (1 of 2)—Males and females 0–14 years. 2017. Excel spreadsheet, cat. no. 2001.0. Retrieved from http://www.censusdata.abs.gov.au/CensusOutput/copsub2016.NSF/All%20docs%20by%20catNo/2016~Community%20Profile~3/$File/GCP_3.zip?OpenElement.
  34. 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.
  35. 35.
    Osman, L. M., Baxter-Jones, A. D. G., & Helms, P. J. (2001). Parents’ quality of life and respiratory symptoms in young children with mild wheeze. European Respiratory Journal, 17(2), 254–258.  https://doi.org/10.1183/09031936.01.17202540.PubMedGoogle Scholar
  36. 36.
    Brunello, G., Fort, M., Schneeweis, N., & Winter-Ebmer, R. (2016). The causal effect of education on health: What is the role of health behaviors? Health Economics, 25(3), 314–336.  https://doi.org/10.1002/hec.3141.PubMedGoogle Scholar
  37. 37.
    Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviors by education. Journal of Health Economics, 29(1), 1–28.  https://doi.org/10.1016/j.jhealeco.2009.10.003.PubMedGoogle Scholar
  38. 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
  39. 39.
    Desager, K. N., Nelen, V., Weyler, J. J. J., & De Backer, W. A. (2005). Sleep disturbance and daytime symptoms in wheezing school-aged children. Journal of Sleep Research, 14(1), 77–82.  https://doi.org/10.1111/j.1365-2869.2004.00432.x.PubMedGoogle Scholar
  40. 40.
    Kapur, N., Masters, I. B., Newcombe, P., & Chang, A. B. (2012). The burden of disease in pediatric non-cystic fibrosis bronchiectasis. Chest, 141(4), 1018–1024.  https://doi.org/10.1378/chest.11-0679.PubMedGoogle Scholar
  41. 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
  42. 42.
    Wiebe, S., Guyatt, G., Weaver, B., Matijevic, S., & Sidwell, C. (2003). Comparative responsiveness of generic and specific quality-of-life instruments. Journal of Clinical Epidemiology, 56(1), 52–60.  https://doi.org/10.1016/s0895-4356(02)00537-1.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Centre for Children’s Health Research, Institute of Health and Biomedical InnovationQueensland University of TechnologySouth BrisbaneAustralia
  2. 2.Menzies School of Health ResearchCharles Darwin UniversityCasuarinaAustralia
  3. 3.Lady Cilento Children’s HospitalQueensland Children’s Hospital and Health ServicesSouth BrisbaneAustralia
  4. 4.School of PsychologyThe University of QueenslandBrisbaneAustralia
  5. 5.Directorate, Institute of Health & Biomedical InnovationQueensland University of TechnologySouth BrisbaneAustralia
  6. 6.Child Health Research CentreUniversity of QueenslandBrisbaneAustralia
  7. 7.Department of Health Services Administration, College of Health SciencesUniversity of SharjahSharjahUnited Arab Emirates

Personalised recommendations