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Original Research: Signs and Symptoms of Chest Disease |

Use of Management Pathways or Algorithms in Children With Chronic Cough: Systematic Reviews

Anne B. Chang, MBBS, PhD; John J. Oppenheimer, MD; Miles Weinberger, MD; Kelly Weir, PhD; Bruce K. Rubin, MD; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

FUNDING/SUPPORT: Dr Chang is supported by a National Health and Medical Research Council (NHMRC) practitioner fellowship (grant 1058213) and holds multiple grants awarded from the NHMRC related to diseases associated with pediatric cough. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC.

CORRESPONDENCE TO: Anne B. Chang, MBBS, PhD, Queensland Children’s Respiratory Centre, Royal Children’s Hospital and Menzies School of Health Research, Charles Darwin University, Herston, Queensland, Brisbane, Queensland 4029, Australia


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):106-119. doi:10.1378/chest.15-1403
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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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