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Use of Management Pathways or Algorithms in Children With Chronic Cough: Systematic Reviews
Anne B Chang1, John J Oppenheimer2, Miles Weinberger3
1Menzies School of Health Research; and Respiratory Deptartment, Lady Cilento Children's Hospital, Queensland University of Technology, Queensland, Australia.
Insights
Cough management protocols improve clinical outcomes in children with chronic cough. Evaluation should consider cough characteristics, not just duration or severity. This aids diagnosis and reduces costs.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
- Systematic Review Methodology
Background:
- Chronic cough in children (>4 weeks) can lead to significant morbidity, delayed diagnosis, and increased healthcare costs.
- Standardized cough management protocols may optimize diagnosis and treatment, reducing adverse outcomes.
- Three systematic reviews addressed key questions regarding pediatric chronic cough management algorithms.
Purpose of the Study:
- To evaluate the effectiveness of cough management protocols in children with chronic cough.
- To determine if cough algorithms should vary based on cough duration, severity, or clinical characteristics.
- To provide evidence-based recommendations for managing chronic cough in pediatric populations.
Main Methods:
- Systematic reviews following the CHEST expert cough panel protocol.
- Inclusion of systematic reviews, randomized controlled trials (RCTs), and cohort studies published in English.
- Data screening, selection, and extraction performed by two authors.
Main Results:
- Nine studies supported the use of cough management protocols (KQ1).
- Eight studies indicated that cough algorithms should differ based on cough characteristics and history (KQ3).
- No studies addressed whether algorithms should differ by duration or severity (KQ2).
Conclusions:
- High-quality evidence supports the use of cough management protocols for children aged ≤14 years with chronic cough.
- Cough management and testing algorithms should be tailored to specific cough characteristics and clinical history.
- Chronic cough in children is defined as >4 weeks duration; systematic evaluation targeting the underlying cause is recommended, regardless of severity.
Background:
Use of appropriate cough pathways or algorithms may reduce the morbidity of chronic cough, lead to earlier diagnosis of chronic underlying illness, and reduce unnecessary costs and medications. We undertook three systematic reviews to examine three related key questions (KQ): In children aged ?14 years with chronic cough (> 4 weeks' duration), KQ1, do cough management protocols (or algorithms) improve clinical outcomes? KQ2, should the cough management or testing algorithm differ depending on the duration and/or severity? KQ3, should the cough management or testing algorithm differ depending on the associated characteristics of the cough and clinical history?
Methods:
We used the CHEST expert cough panel's protocol. Two authors screened searches and selected and extracted data. Only systematic reviews, randomized controlled trials (RCTs), and cohort studies published in English were included.
Results:
Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-analyses flowcharts and summary tabulated. Nine studies were included in KQ1 (RCT = 1; cohort studies = 7) and eight in KQ3 (RCT = 2; cohort = 6), but none in KQ2.
Conclusions:
There is high-quality evidence that in children aged ?14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes and cough management or the testing algorithm should differ depending on the associated characteristics of the cough and clinical history. It remains uncertain whether the management or testing algorithm should depend on the duration or severity of chronic cough. Pending new data, chronic cough in children should be defined as > 4 weeks' duration and children should be systematically evaluated with treatment targeted to the underlying cause irrespective of the cough severity.
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