The Dual Burden of Childcare Settings and Air Pollution on Recurrent Coughs in Preschoolers
Dear Editor
The article by Peek and Coll. on chronic cough in preschoolers highlights a significant health issue in young children. I want to expand on the factors contributing to recurrent, persistent, and chronic coughs in this age group, mainly focusing on the roles of childcare settings and air pollution.
Respiratory infections are among the most common health issues in preschool-aged children, leading to significant morbidity. Among the various manifestations, chronic coughs stand out due to their persistent nature and impact on the child’s quality of life.
In cases of recurrent infections, inflammation and irritation of the respiratory tract may persist even after the initial infection has resolved, leading to a cycle of chronic coughing. This situation is prevalent in children exposed to multiple infections within a short timeframe (1).
Chronic coughs in preschool-aged children are often linked to repeated respiratory infections, particularly in childcare settings. These environments foster the frequent sharing and transmission of upper respiratory infections due to the close physical proximity, shared spaces, and the developing hygiene practices of young children.
Preschool children are especially vulnerable due to their immature immune systems, making them more susceptible to infections that lead to persistent or recurrent coughs. Children attending daycare have higher rates of respiratory illnesses than those cared for at home (2). Furthermore, an increased risk of chronic cough exists even for children who do not attend childcare settings but live with siblings who do. These siblings often bring home pathogens from school or daycare, exposing the entire household. This indirect exposure increases the likelihood of recurrent respiratory symptoms and chronic coughs in younger children with less developed immune systems (3).
In addition to the high transmission rates of respiratory infections within childcare settings, exposure to air pollution further compounds the risk of chronic coughs in preschool-aged children. Air pollution, particularly in urban areas, contributes to the inflammation and irritation of the respiratory tract, making children more susceptible to the effects of respiratory infections. Pollutants such as particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) are known to aggravate respiratory symptoms, increase the severity of infections, and prolong recovery times (4-7).
For children already exposed to frequent infections in childcare settings, the added burden of polluted air can overwhelm their developing immune systems, leading to persistent coughs that do not resolve easily. It has been shown that children concurrently exposed to high levels of air pollution and respiratory infections experience more severe respiratory outcomes, including prolonged episodes of cough and a higher incidence of conditions like bronchitis and asthma. This dual exposure is particularly concerning in densely populated urban areas where childcare facilities are often near busy roads or industrial zones, increasing the likelihood of adverse health outcomes.
In these environments, even low-level, chronic exposure to pollutants can have a cumulative effect, exacerbating the inflammatory response initiated by repeated infections. Consequently, children attending childcare centers in polluted areas are at a significantly higher risk of developing chronic coughs, which may persist or recur more frequently than children not exposed to such pollution levels or who do not attend group care settings. Addressing childcare environment factors and urban air pollution is crucial for mitigating chronic cough and enhancing the respiratory health of preschool children.
References
1. Kantar A, Bernardini R, Paravati F, Minasi D, Sacco O. Chronic cough in preschool children. Early Hum Dev. 2013 Oct;89 Suppl 3:S19-24. doi: 10.1016/j.earlhumdev.2013.07.018.
2. Kramarchuk VV. Risk factors of recurrent respiratory infections in early school-age children. Bukovinian Med Herald. 2023;27(3):25-9. doi: 10.24061/2413-0737.27.3.107.2023.5.
3. Trandafir LM, Boiculese LV, Dimitriu G, Moscalu M. Recurrent respiratory tract infections in children. 2017 E-Health and Bioengineering Conference (EHB); 2017 Nov 22-24; Sinaia, Romania. IEEE; 2017. p. 741-4. doi: 10.1109/EHB.2017.7995530.
4. Cheng J, Su H, Xu Z. Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children. Environ Pollut. 2021 Jan 1;268(Pt A):115698. doi: 10.1016/j.envpol.2020.115698.
5. Liu Y, Deng M, Zhang D, Lu C, Lu S. Effect of preconception, prenatal and postnatal exposure to ambient air pollution on laryngitis in southern Chinese children. Front Environ Sci. 2022;10:830106.
6. Wang ZB, Ren L, Lu QB, Zhang XA, Miao D, Hu YY, et al. The impact of weather and air pollution on viral infection and disease outcome among pediatric pneumonia patients in Chongqing, China, from 2009 to 2018: A prospective observational study. Clin Infect Dis. 2021 Jul 15;73(2):e513-22. doi: 10.1093/cid/ciaa997.
7. Cardinale F, La Torre F, Tricarico LG, Verriello G, Mastrorilli C. Why do some children get sick with recurrent respiratory infections? Curr Pediatr Rev. 2024;20(3):203-15. doi: 10.2174/1573396320666230912103056.
Competing interests:
No competing interests
02 September 2024
Giovanni Ghirga
Pediatrician
Claudia Orchi, MD, Pediatrician
Member of the Scientific Committee of the Italian Branch of the International Society of Doctors for the Environment, Basel, Switzerland.
Rapid Response:
The Dual Burden of Childcare Settings and Air Pollution on Recurrent Coughs in Preschoolers
Dear Editor
The article by Peek and Coll. on chronic cough in preschoolers highlights a significant health issue in young children. I want to expand on the factors contributing to recurrent, persistent, and chronic coughs in this age group, mainly focusing on the roles of childcare settings and air pollution.
Respiratory infections are among the most common health issues in preschool-aged children, leading to significant morbidity. Among the various manifestations, chronic coughs stand out due to their persistent nature and impact on the child’s quality of life.
In cases of recurrent infections, inflammation and irritation of the respiratory tract may persist even after the initial infection has resolved, leading to a cycle of chronic coughing. This situation is prevalent in children exposed to multiple infections within a short timeframe (1).
Chronic coughs in preschool-aged children are often linked to repeated respiratory infections, particularly in childcare settings. These environments foster the frequent sharing and transmission of upper respiratory infections due to the close physical proximity, shared spaces, and the developing hygiene practices of young children.
Preschool children are especially vulnerable due to their immature immune systems, making them more susceptible to infections that lead to persistent or recurrent coughs. Children attending daycare have higher rates of respiratory illnesses than those cared for at home (2). Furthermore, an increased risk of chronic cough exists even for children who do not attend childcare settings but live with siblings who do. These siblings often bring home pathogens from school or daycare, exposing the entire household. This indirect exposure increases the likelihood of recurrent respiratory symptoms and chronic coughs in younger children with less developed immune systems (3).
In addition to the high transmission rates of respiratory infections within childcare settings, exposure to air pollution further compounds the risk of chronic coughs in preschool-aged children. Air pollution, particularly in urban areas, contributes to the inflammation and irritation of the respiratory tract, making children more susceptible to the effects of respiratory infections. Pollutants such as particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), and sulfur dioxide (SO2) are known to aggravate respiratory symptoms, increase the severity of infections, and prolong recovery times (4-7).
For children already exposed to frequent infections in childcare settings, the added burden of polluted air can overwhelm their developing immune systems, leading to persistent coughs that do not resolve easily. It has been shown that children concurrently exposed to high levels of air pollution and respiratory infections experience more severe respiratory outcomes, including prolonged episodes of cough and a higher incidence of conditions like bronchitis and asthma. This dual exposure is particularly concerning in densely populated urban areas where childcare facilities are often near busy roads or industrial zones, increasing the likelihood of adverse health outcomes.
In these environments, even low-level, chronic exposure to pollutants can have a cumulative effect, exacerbating the inflammatory response initiated by repeated infections. Consequently, children attending childcare centers in polluted areas are at a significantly higher risk of developing chronic coughs, which may persist or recur more frequently than children not exposed to such pollution levels or who do not attend group care settings. Addressing childcare environment factors and urban air pollution is crucial for mitigating chronic cough and enhancing the respiratory health of preschool children.
References
1. Kantar A, Bernardini R, Paravati F, Minasi D, Sacco O. Chronic cough in preschool children. Early Hum Dev. 2013 Oct;89 Suppl 3:S19-24. doi: 10.1016/j.earlhumdev.2013.07.018.
2. Kramarchuk VV. Risk factors of recurrent respiratory infections in early school-age children. Bukovinian Med Herald. 2023;27(3):25-9. doi: 10.24061/2413-0737.27.3.107.2023.5.
3. Trandafir LM, Boiculese LV, Dimitriu G, Moscalu M. Recurrent respiratory tract infections in children. 2017 E-Health and Bioengineering Conference (EHB); 2017 Nov 22-24; Sinaia, Romania. IEEE; 2017. p. 741-4. doi: 10.1109/EHB.2017.7995530.
4. Cheng J, Su H, Xu Z. Intraday effects of outdoor air pollution on acute upper and lower respiratory infections in Australian children. Environ Pollut. 2021 Jan 1;268(Pt A):115698. doi: 10.1016/j.envpol.2020.115698.
5. Liu Y, Deng M, Zhang D, Lu C, Lu S. Effect of preconception, prenatal and postnatal exposure to ambient air pollution on laryngitis in southern Chinese children. Front Environ Sci. 2022;10:830106.
6. Wang ZB, Ren L, Lu QB, Zhang XA, Miao D, Hu YY, et al. The impact of weather and air pollution on viral infection and disease outcome among pediatric pneumonia patients in Chongqing, China, from 2009 to 2018: A prospective observational study. Clin Infect Dis. 2021 Jul 15;73(2):e513-22. doi: 10.1093/cid/ciaa997.
7. Cardinale F, La Torre F, Tricarico LG, Verriello G, Mastrorilli C. Why do some children get sick with recurrent respiratory infections? Curr Pediatr Rev. 2024;20(3):203-15. doi: 10.2174/1573396320666230912103056.
Competing interests: No competing interests