Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis CHEST Guideline and Expert Panel Report

Authors

Anne B. Chang, Menzies School of Health Research, Lady Cilento Children's Hospital, Queensland University of Technology
John J. Oppenheimer, New Jersey Medical School
Miles M. Weinberger, University of Iowa
Bruce K. Rubin, Virginia Commonwealth University
Cameron C. Grant, University of Auckland
Kelly Weir, Griffith University
Richard S. Irwin, University of Massachusetts
CHEST Expert Cough Panel

Document Type

Article

Original Publication Date

2017

Journal/Book/Conference Title

CHEST

Volume

151

Issue

4

First Page

884

Last Page

890

DOI of Original Publication

10.1016/j.chest.2017.01.025

Comments

Originally published at http://doi.org/10.1016/j.chest.2017.01.025

Date of Submission

June 2017

Abstract

BACKGROUND: Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged
METHODS: We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). 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 4 weeks' duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, 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.

CONCLUSIONS: Compared with 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.

Rights

Copyright (C) 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved

Is Part Of

VCU Pediatrics Publications