Managing Chronic Cough as a Symptom in Children and Management Algorithms. CHEST Guideline and Expert Panel Report

Anne B. Chang*, John Oppenheimer, Richard S. Irwin, Todd M. Adams, Kenneth W. Altman, Elie Azoulay, Fiona Blackhall, Surinder S. Birring, Donald C. Bolser, Louis Philippe Boulet, Sidney S. Braman, Christopher Brightling, Priscilla Callahan-Lyon, Terrie Cowley, Paul Davenport, Ali A. El Solh, Patricio Escalante, Stephen K. Field, Dina Fisher, Cynthia T. FrenchCameron Grant, Susan M. Harding, Anthony Harnden, Adam T. Hill, Peter J. Kahrilas, Joanne Kavanagh, Karina A. Keogh, Kefang Lai, Mark Lown, Craig Lilly, Kaiser Lim, Mark Lown, J. Mark Madison, Mark A. Malesker, Stuart Mazzone, Lorcan McGarvey, Alex Molasoitis, M. Hassan Murad, Mangala Narasimhan, John Oppenheimer, Richard J. Russell, Jay H. Ryu, Sonal Singh, Maeve P. Smith, Susan M. Tarlo, Anne E. Vertigan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)

Abstract

Background: Cough is one of the most common presenting symptoms to general practitioners. The objective of this article is to collate the pediatric components of the CHEST chronic cough guidelines that have recently updated the 2006 guidelines to assist general and specialist medical practitioners in the evaluation and management of children who present with chronic cough. 

Methods: We reviewed all current CHEST Expert Cough Panel's statements and extracted recommendations and suggestions relating to children aged ≤ 14 years with chronic cough (> 4 weeks duration). Additionally, we undertook systematic reviews to update other sections we considered relevant and important. 

Results: The eight recent CHEST guidelines relevant to children, based on systematic reviews, reported some high-quality evidence in the management of chronic cough in children (eg, use of algorithms and management of wet/productive cough using appropriate antibiotics). However, much evidence is still inadequate, particularly in the management of non-specific cough in the community. 

Conclusions: The recommendations and suggestions related to the management of chronic cough in the pediatric age group have been based upon high-quality systematic reviews and are summarized in this article. Compared to the 2006 Cough Guidelines, there is now high-quality evidence for some aspects of the management of chronic cough in children. However, further studies particularly in primary health care are required.

Original languageEnglish
Pages (from-to)303-329
Number of pages27
JournalChest
Volume158
Issue number1
Early online date13 Mar 2020
DOIs
Publication statusPublished - 01 Jul 2020

Bibliographical note

Funding Information:
Author contributions: All authors contributed to the design and analysis of the study and writing of the manuscript. A. B. C. performed the searches that update the 2006 recommendations/suggestions described in recommendations number 13, 14, 36, and 37; the search strings and summary of evidence for these appear in the supplementary file. Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. C. is an author and reviewer UpToDate; data safety monitoring board member for a vaccine study (Glaxo); advisor for study design of an unlicensed product (Merck); has also received multiple peer-reviewed competitive grants [1154302, 1170958, 1042601] from the Australian National Health and Medical Research Council (NHMRC). No financial conflicts of interest regarding the content of this manuscript. A. B. C. is supported by an NHMRC practitioner fellowship [grant 1154302] and holds multiple grants awarded from the NHMRC related to diseases associated with pediatric cough. J. J. O. reports the following: American Board of Allergy and Immunology, Board of Directors; Annals of Allergy and Allergy Watch, Associate Editor; UpToDate, reviewer; Clinical Research, AstraZeneca, Boehringer Ingelheim, Glaxo, Medimmune, and Novartis; Adjudication Committee, AstraZeneca and Novartis; data safety monitoring board, The Ohio State University; and consultant, Glaxo, Myelin, Church and Dwight, and Meda. R. S. I. has no financial or intellectual conflicts of interest regarding the content of this manuscript. Moreover, while RSI was the Editor in Chief of CHEST, the review and all editorial decisions regarding this manuscript were independently made by others. Role of sponsors: CHEST was the sole supporter of these guidelines, this article, and the innovations addressed within. ?CHEST Expert Cough Panel Collaborators: Todd M. Adams, MD (Webhannet Internal Medicine Associates of York Hospital), Kenneth W. Altman, MD, PhD (Geisinger Medical Center), Elie Azoulay, MD, PhD (University of Paris), Alan F. Barker, MD (Oregon Health & Science University), Fiona Blackhall, MD, PhD (University of Manchester, Department of Medical Oncology), Surinder S. Birring, MBChB, MD (Division of Asthma, Allergy and Lung Biology, King's College London), Donald C. Bolser, PhD, Louis-Philippe Boulet, MD, FCCP (Institut universitaire de cardiologie et de pneumonlogie de Qu?bec), Sidney S. Braman, MD, Christopher Brightling, MBBS, PhD, FCCP (University of Leicester, Glenfield Hospital), Priscilla Callahan-Lyon, MD (Adamstown, MD), Anne B. Chang, MBBS, PhD, MPH (Royal Children's Hospital), Terrie Cowley (The TMJ Association), Paul Davenport, PhD (Department of Physiological Sciences, University of Florida), Ali A. El Solh, MD, MPH (University at Buffalo, State University of New York), Patricio Escalante, MD, MSc, FCCP (Mayo Clinic), Stephen K. Field, MD (University of Calgary), Dina Fisher, MD, MSc (University of Calgary, Respiratory Medicine), Cynthia T. French, PhD, FCCP (UMass Memorial Medical Center), Cameron Grant, MB ChB, PhD (University of Auckland), Susan M. Harding, MD, FCCP (Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham), Anthony Harnden, MB ChB, MSc (University of Oxford), Adam T. Hill, MB ChB, MD (Royal Infirmary and University of Edinburgh), Richard S. Irwin, MD, Master FCCP (UMass Memorial Medical Center), Peter J. Kahrilas, MD (Feinberg School of Medicine, Northwestern University), Joanne Kavanagh, MBChB, (Division of Asthma, Allergy and Lung Biology, King's College London), Karina A. Keogh, MD (Mayo Clinic), Kefang Lai, MD, PhD (First Affiliated Hospital of Guangzhou Medical College), Andrew P. Lane, MD (Johns Hopkins University School of Medicine), Craig Lilly, MD, FCCP (UMass Memorial Medical Center), Kaiser Lim, MD (Mayo Clinic), Mark Lown, MB BS, PhD, J. Mark Madison, MD, FCCP (UMass Memorial Medical Center), Mark A. Malesker, PharmD, FCCP (Creighton University School of Pharmacy and Health Professions), Stuart Mazzone, PhD, FCCP (University of Melbourne), Lorcan McGarvey, MD (The Queens University Belfast), Alex Molasoitis, PhD, MSc, RN (Hong Kong Polytechnic University), M. Hassan Murad, MD, MPH (Mayo Clinic), Mangala Narasimhan, DO, FCCP (Hofstra-Northwell Health), John Oppenheimer, MD (UMDNJ-Rutgers University), Richard J. Russell, MBBS (University of Leicester, Glenfield Hospital), Jay H. Ryu, MD, FCCP (Mayo Clinic), Sonal Singh, MD, MPH (UMass Memorial Medical Center), Maeve P. Smith, MB ChB, MD (University of Alberta), Susan M. Tarlo, MBBS, FCCP (Toronto Western Hospital), and Anne E. Vertigan, PhD, MBA, BAppSc (SpPath) (John Hunter Hospital). Endorsements: This guideline has been endorsed by the American Association for Respiratory Care. Other contributions: Bruce K. Rubin, MD (Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University) and Miles M. Weinberger, MD, FCCP (Department of Pediatrics, University of California San Diego, Rady Children's Hospital) served on the CHEST Expert Cough Panel. Education and Clinical Services Librarians working in the University of Massachusetts Medical School Library (Nancy Harger, MLS and Judy Nordberg, MLS) performed all but four of the systematic searches for each patient, intervention, comparison, outcome question. Additional information: The e-Tables can be found in the Supplemental Materials section of the online article.

Funding Information:
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. C. is an author and reviewer UpToDate; data safety monitoring board member for a vaccine study (Glaxo); advisor for study design of an unlicensed product (Merck); has also received multiple peer-reviewed competitive grants [1154302, 1170958, 1042601] from the Australian National Health and Medical Research Council (NHMRC). No financial conflicts of interest regarding the content of this manuscript. A. B. C. is supported by an NHMRC practitioner fellowship [grant 1154302] and holds multiple grants awarded from the NHMRC related to diseases associated with pediatric cough. J. J. O. reports the following: American Board of Allergy and Immunology, Board of Directors; Annals of Allergy and Allergy Watch, Associate Editor; UpToDate, reviewer; Clinical Research, AstraZeneca, Boehringer Ingelheim, Glaxo, Medimmune, and Novartis; Adjudication Committee, AstraZeneca and Novartis; data safety monitoring board, The Ohio State University; and consultant, Glaxo, Myelin, Church and Dwight, and Meda. R. S. I. has no financial or intellectual conflicts of interest regarding the content of this manuscript. Moreover, while RSI was the Editor in Chief of CHEST, the review and all editorial decisions regarding this manuscript were independently made by others.

Publisher Copyright:
© 2020 American College of Chest Physicians

Keywords

  • children
  • cough
  • evidence-based medicine
  • guideline
  • treatment

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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