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Children With Chronic Wet or Productive Cough--Treatment and Investigations: A Systematic Review
Anne B Chang1, John J Oppenheimer2, Miles Weinberger3
1Child Health Division, Menzies School of Health Research, Darwin, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, Queensland Uni of Technology, Children's Health Queensland, Queensland, Australia.
Insights
Antibiotics effectively treat chronic wet cough in children under 14, improving resolution. Refer children with persistent cough or specific indicators for further investigations to rule out underlying lung diseases.
Area of Science:
- Pediatric Pulmonology
- Evidence-Based Medicine
- Pharmacotherapy
Background:
- Chronic wet or productive cough in children (>4 weeks) requires clear management guidelines.
- Distinguishing between self-limiting conditions and those needing further investigation is crucial.
- Antibiotic efficacy and referral criteria for pediatric chronic cough remain areas of interest.
Purpose of the Study:
- To evaluate the effectiveness of antibiotics for chronic wet cough in children.
- To determine optimal antibiotic choices and duration for pediatric chronic cough.
- To establish criteria for referring children with chronic wet cough for further investigations.
Main Methods:
- Systematic reviews of randomized controlled trials (RCTs), cohort studies, and cross-sectional studies.
- Data extraction and synthesis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Analysis of 15 studies for antibiotic efficacy (KQ1) and 17 studies for referral criteria (KQ2).
Main Results:
- High-quality evidence shows antibiotics improve cough resolution in children aged ≤14 years.
- The number needed to treat for benefit with antibiotics was 3.
- Specific indicators (e.g., digital clubbing) warrant further investigation; referral is advised if cough persists after 4 weeks of antibiotics.
Conclusions:
- Appropriate antibiotic use is effective for chronic wet cough in children.
- Referral for advanced investigations is recommended for persistent or complex cases.
- Early identification and management of underlying lung diseases are critical.
Background:
Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks' duration) wet or productive cough not related to bronchiectasis: KQ1-How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2-When should they be referred for further investigations?
Methods:
The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English.
Results:
Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95% CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations.
Conclusions:
There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.
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