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Chronic Cough Related to Acute Viral Bronchiolitis in Children: CHEST Expert Panel Report
Anne B Chang1, John J Oppenheimer2, Bruce K Rubin3
1Division of Child Health, Menzies School of Health Research, Darwin, Australia; Respiratory and Sleep Department, Lady Cilento Children's Hospital, Qld Uni of Technology, Brisbane, QLD, Australia.
Insights
This study found no evidence to recommend antibiotics, asthma medications, or hypertonic saline for treating chronic cough in children after acute viral bronchiolitis. Further research is needed for effective management strategies.
Area of Science:
- Pediatric Pulmonology
- Evidence-Based Medicine
Background:
- Acute bronchiolitis is a common childhood illness.
- A subset of children experience persistent chronic cough exceeding four weeks post-infection.
Purpose of the Study:
- To systematically review the efficacy of antibiotics, asthma medications, and inhaled osmotic agents for chronic cough post-bronchiolitis in children.
- To formulate evidence-based recommendations for managing this condition.
Main Methods:
- Systematic reviews were conducted using PICO format and CHEST guidelines.
- GRADE framework and Delphi methodology were employed to reach consensus.
- Patient values and clinical context were integrated into suggestions.
Main Results:
- No relevant data were found for the efficacy of antibiotics, asthma medications, or hypertonic saline in addressing chronic cough post-bronchiolitis.
- Consequently, no recommendations could be formulated for these interventions.
Conclusions:
- Consensus-based suggestions were developed in the absence of direct evidence.
- Future research directions were identified to improve the management of chronic cough in children following acute viral bronchiolitis.
Background:
Acute bronchiolitis is common in young children, and some children develop chronic cough after their bronchiolitis. We thus undertook systematic reviews based on key questions (KQs) using the PICO (Population, Intervention, Comparison, Outcome) format. The KQs were: Among children with chronic cough (> 4 weeks) after acute viral bronchiolitis, how effective are the following interventions in improving the resolution of cough?: (1) Antibiotics. If so what type and for how long? (2) Asthma medications (inhaled steroids, beta2 agonist, montelukast); and (3) Inhaled osmotic agents like hypertonic saline?
Methods:
We used the CHEST expert cough panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and GRADE framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form these suggestions. Delphi methodology was used to obtain consensus.
Results:
Several studies and systematic reviews on the efficacy of the three types of interventions listed in the introduction were found but no data were relevant to our KQs. Thus, no recommendations on using the interventions above could be formulated.
Conclusions:
The panel made several consensus-based suggestions and identified directions for future studies to advance the field of managing chronic cough post-acute bronchiolitis in children.
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