0
Original Research: Signs and Symptoms of Chest Disease |

Children With Chronic Wet or Productive Cough—Treatment and Investigations: A Systematic Review

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

CORRESPONDENCE TO: Anne B. Chang, MBBS, PhD, Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, Queensland 4101, Australia


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


Chest. 2016;149(1):120-142. doi:10.1378/chest.15-2065
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016;51(5):450-69.
Bronchiectasis in yellow nail syndrome. Respirology Published online Aug 23, 2016;
Guidelines
Feverish illness in children: assessment and initial management in children younger than 5 years.
National Collaborating Centre for Women's and Children's Health | 8/28/2009
Blepharitis.
American Academy of Ophthalmology | 6/5/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543