Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report

Area of Science:

• Pediatric Pulmonology
• Evidence-Based Medicine
• Clinical Practice Guidelines

Background:

• Chronic cough in children (≤ 14 years) management can be improved with structured algorithms.
• Systematic reviews were conducted to evaluate generic approaches to chronic cough management.
• Key questions (KQs) were addressed using the Population, Intervention, Comparison, Outcome (PICO) framework.

Purpose of the Study:

• To systematically review the effectiveness of cough management algorithms in children.
• To provide evidence-based recommendations for the management of chronic cough in pediatric populations.
• To compare current evidence with previous guidelines (2006 Cough Guidelines).

Main Methods:

• Systematic reviews were performed following the CHEST Expert Cough Panel protocol.
• Methodological guidelines from the American College of Chest Physicians (CHEST) were utilized.
• Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and Delphi methodology informed recommendations and final grading.

Main Results:

• High-quality evidence confirms that a systematic approach to chronic cough management improves clinical outcomes in children.
• The CHEST approach demonstrated the highest level of evidence among reviewed pathways.
• Limited evidence was found for certain specific questions (KQs) within the reviews.

Conclusions:

• High-quality evidence supports the use of cough management protocols for children (≤ 14 years) with chronic cough (> 4 weeks).
• Management and testing algorithms should be tailored to the child's specific cough characteristics and clinical history.
• Recommended initial investigations include chest radiography and spirometry (when age-appropriate); other tests should be guided by clinical presentation and specific concerns like tuberculosis exposure.