Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤14-years) based on key questions using the PICO format.
We used the CHEST expert cough panel’s protocol for the systematic reviews 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 recommendations. Delphi methodology was used to obtain the final grading.
Combining data from systematic reviews addressing 5 key questions, we found high quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. While there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the key questions posed.
Compared to the 2006 Cough Guidelines, there is now 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 testing algorithm should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre and post β2 agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance to the clinical setting and the child’s clinical symptoms and signs (e.g. tests for tuberculosis when child has been exposed).