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Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report
Anne B Chang1, John J Oppenheimer2, Richard S Irwin3
1Division of Child Health, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland's University of Technology, Brisbane, QLD, Australia.
Insights
Updated CHEST guidelines offer high-quality evidence for managing pediatric chronic cough, particularly for wet cough. Further research is needed for non-specific cough in primary care.
Area of Science:
- Pediatric Pulmonology
- Clinical Practice Guidelines
Background:
- Chronic cough is a frequent pediatric symptom encountered by general practitioners.
- Recent updates to the CHEST chronic cough guidelines address pediatric management.
Purpose of the Study:
- To consolidate pediatric recommendations from the updated CHEST chronic cough guidelines.
- To aid medical practitioners in evaluating and managing chronic cough in children.
Main Methods:
- Systematic review of CHEST Expert Cough Panel statements for children ≤ 14 years with chronic cough (> 4 weeks).
- Inclusion of systematic reviews to update relevant guideline sections.
Main Results:
- High-quality evidence exists for some pediatric chronic cough management aspects, like algorithmic approaches and antibiotic use for wet cough.
- Evidence remains insufficient for managing non-specific chronic cough in community settings.
Conclusions:
- Updated CHEST guidelines provide high-quality evidence for specific pediatric chronic cough management strategies.
- Further research, especially in primary healthcare, is necessary to improve management of non-specific chronic cough in children.
Background:
Cough is one of the most common presenting symptoms to general practitioners. 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 reviews, 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 antibiotics). However, much evidence is still inadequate, particularly in the management of non-specific 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.
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