Use of Management Pathways or Algorithms in Children With Chronic Cough CHEST Guideline and Expert Panel Report

Authors

Anne B. Chang, Menzies School of Health Research, Queensland University of Technology
John J. Oppenheimer, University of Medicine & Dentistry New Jersey, Pulmonary and Allergy Associates
Miles M. Weinberger, University of Iowa
Bruce K. Rubin, Virginia Commonwealth University
Kelly Weir, Lady Cilento Children’s Hospital
Cameron C. Grant, University of Auckland
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

875

Last Page

883

DOI of Original Publication

10.1016/j.chest.2016.12.025

Comments

Originally published at http://doi.org/10.1016/j.chest.2016.12.025

Date of Submission

June 2017

Abstract

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 (KQs) using the Population, Intervention, Comparison, Outcome 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 Grading of Recommendations Assessment, Development and Evaluation 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 five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although 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 KQs posed.

CONCLUSIONS: Compared with the 2006 Cough Guidelines, there is now high-quality evidence that in children aged 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes, and cough management or testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre-and post-beta(2) agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed).

Rights

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

Is Part Of

VCU Pediatrics Publications