xRead - Globus and Chronic Cough (April 2024)

[ Education and Clinical Practice Guidelines and Consensus Statements ]

Managing Chronic Cough as a Symptom in Children and Management Algorithms CHEST Guideline and Expert Panel Report

Anne B. Chang, PhD; John J. Oppenheimer, MD; and Richard S. Irwin, MD, Master FCCP; on behalf of the CHEST Expert Cough Panel *

BACKGROUND: Cough is one of the most common presenting symptoms to general practi tioners. The objective of this article is to collate the pediatric components of the CHEST chronic cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with chronic cough. METHODS: We reviewed all current CHEST Expert Cough Panel ’ s statements and extracted recommendations and suggestions relating to children aged # 14 years with chronic cough ( > 4 weeks duration). Additionally, we undertook systematic reviews to update other sections we considered relevant and important. RESULTS: The eight recent CHEST guidelines relevant to children, based on systematic re views, reported some high-quality evidence in the management of chronic cough in children (eg, use of algorithms and management of wet/productive cough using appropriate antibi otics). However, much evidence is still inadequate, particularly in the management of non speci fi c cough in the community. CONCLUSIONS: The recommendations and suggestions related to the management of chronic cough in the pediatric age group have been based upon high-quality systematic reviews and are summarized in this article. Compared to the 2006 Cough Guidelines, there is now high quality evidence for some aspects of the management of chronic cough in children. However, further studies particularly in primary health care are required. CHEST 2020; 158(1):303-329

KEYWORDS: children; cough; evidence-based medicine; guideline; treatment

Morristown, NJ; and the Division of Pulmonary, Allergy, and Critical Care Medicine (Dr Irwin), Department of Medicine, UMass Memorial Medical Center, Worcester, MA. *Collaborators from the CHEST Expert Cough Panel are listed in the Acknowledgments. The views expressed in this publication are those of the authors and do not re fl ect the views of the Australian National Health and Medical Research Council. CORRESPONDENCE TO: Anne B. Chang, PhD, Department of Respi ratory Medicine, Queensland Children ’ s Hospital, Brisbane, QLD, 4101, Australia; e-mail: annechang@ausdoctors.net Copyright 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. DOI: https://doi.org/10.1016/j.chest.2020.01.042

ABBREVIATIONS: AHR = airway hyper-responsiveness; ARI = acute respiratory infection; CHEST = American College of Chest Physicians; CS = inhaled corticosteroids; CXR = chest radiograph; FB = fl exible bronchoscopy; F ENO = fractional exhaled nitric oxide; GER = GI gastroesophageal re fl ux; GERD = gastroesophageal re fl ux disease; OTC = over-the-counter; PBB = protracted bacterial bronchitis; PCR = polymerase chain reaction; QoL = quality of life; RCT = randomized controlled trial; URTI = upper respiratory tract infection; Xpert MTB/ RIF = automated real-time nucleic acid ampli fi cation technology for rapid and simultaneous detection of TB and rifampin resistance AFFILIATIONS: Division of Child Health (Dr Chang), Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine (Dr Chang), Queensland Children ’ s Hospital, Queensland ’ s University of Technology, Brisbane, QLD, Australia; Division of Allergy and Immunology (Dr Oppenheimer), Department of Medicine, UMDNJ-Rutgers and Pulmonary and Allergy Associates,

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