Evidence-Based Medicine |

Use of management pathways or algorithms in children with chronic cough: CHEST Guideline and Expert Panel Report FREE TO VIEW

Anne B. Chang, FRACP, PhD; John J. Oppenheimer, MD; Miles M. Weinberger, MD, FCCP; Bruce K. Rubin, FRCPC, MD; Kelly Weir, PhD; Cameron C. Grant, FRACP, PhD; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

Conflict of Interests table:

ABC: Intellectual CoI being an author of several of the papers included in this review (as detailed in ‘bias section’ of the systematic review paper published earlier .1 No financial or intellectual conflicts of interest

JJO: American Board of Allergy and Immunology - Board of Directors, Annals of Allergy and Allergy Watch - Associate Editor, Up to Date – reviewer, Clinical Research - BI, AZ, Glaxo, Medimmune and Novartis, Adjudication Committee – AZ and Novartis, DSMB - Ohio State University, Consultant - Glaxo, Myelin, Church and Dwight, and Meda

MMW: No financial or intellectual conflicts of interest

BKR: No financial or intellectual conflicts of interest

KW: No financial or intellectual conflicts of interest

GCC: No financial or intellectual conflicts of interest

RSI: No financial or intellectual conflicts of interest regarding the content of this manuscript. Moreover, while RSI is the Editor in Chief of CHEST, the review and all editorial decisions regarding this manuscript were independently made by others

aMenzies School of Health Research

bRespiratory Dept, Lady Cilento Children’s Hospital, Qld Uni of Technology Queensland, Australia

cNew Jersey Medical School, Pulmonary and Allergy Associates, Morristown, New Jersey

dUMass Memorial Medical Center, Worcester, MA

eLady Cilento Children’s Hospital, Brisbane, Australia

fChildren’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA

gDepartment of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand

hPediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, Iowa, USA

Corresponding author Anne Chang Dept of Respiratory and Sleep medicine Lady Cilento Children’s Hospital, South Brisbane, Queensland 4101, Australia.

Copyright 2017, . All Rights Reserved.

Chest. 2017. doi:10.1016/j.chest.2016.12.025
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Background  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.

Methods  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.

Results  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.

Conclusion  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).

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