Evidence-Based Medicine |

Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST Guideline and Expert Panel Report FREE TO VIEW

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

Conflict of Interests: ABC has an intellectual CoI being an author of several of the papers included in this review. JJO declares the following; 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. RSI reports that he has 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. All other authors do not have any conflict of interest.

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, USA

dUMass Memorial Medical Center, Worcester, MA, USA

eGriffith University, Gold Coast, Qld, Australia

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

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 Prof Anne Chang Dept of Respiratory and Sleep medicine Lady Cilento Children’s Hospital, South Brisbane, Queensland 4101, Australia Tel: 61 7 30681111

Copyright 2017, . All Rights Reserved.

Chest. 2017. doi:10.1016/j.chest.2017.01.025
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Background  Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews relating to the management of chronic wet cough in children (aged ≤14-years) based on key questions (KQ1)-how effective are antibiotics in improving the resolution of cough? If so, what and for how long? and; (KQ2)-when should children be referred for further investigations?

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 consensus for the recommendations/suggestions made.

Results  Combining data from the systematic reviews, we found high quality evidence in children aged ≤14-years with chronic (>4-weeks duration) wet/productive cough that using appropriate antibiotics improves cough resolution and; further investigations (e.g. flexible bronchoscopy, chest CTs and immunity tests) should be undertaken when specific cough pointers (e.g. digital clubbing) are present. When the wet cough does not improve following 4-weeks of antibiotics there is moderate quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis.

Conclusion  Compared to the 2006 Cough Guidelines, there is now high quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies particularly in primary health are required.

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