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?
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.
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.
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.