Anne B Chang1, John J Oppenheimer2, Miles M Weinberger3, Bruce K Rubin4, Cameron C Grant5, Kelly Weir6, Richard S Irwin7. 1. Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; Queensland University of Technology, QLD, Australia. Electronic address: annechang@ausdoctors.net. 2. New Jersey Medical School, Pulmonary and Allergy Associates, Morristown, NJ. 3. Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA. 4. Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA. 5. Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand. 6. Griffith University, Gold Coast, QLD, Australia. 7. UMass Memorial Medical Center, Worcester, MA.
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 ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations? 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 ≤ 14 years with chronic (> 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.
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 ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations? 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 ≤ 14 years with chronic (> 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.
Authors: Anne B Chang; John J Oppenheimer; Peter J Kahrilas; Ahmad Kantar; Bruce K Rubin; Miles Weinberger; Richard S Irwin Journal: Chest Date: 2019-04-16 Impact factor: 9.410
Authors: Anne B Chang; John J Oppenheimer; Miles Weinberger; Cameron C Grant; Bruce K Rubin; Richard S Irwin Journal: Chest Date: 2017-06-21 Impact factor: 9.410
Authors: Jennifer L Perret; Danielle Wurzel; E Haydn Walters; Adrian J Lowe; Caroline J Lodge; Dinh S Bui; Bircan Erbas; Gayan Bowatte; Melissa A Russell; Bruce R Thompson; Lyle Gurrin; Paul S Thomas; Garun Hamilton; John L Hopper; Michael J Abramson; Anne B Chang; Shyamali C Dharmage Journal: BMJ Open Respir Res Date: 2022-06
Authors: Hamdan Al-Jahdali; Abdullah Alshimemeri; Abdullah Mobeireek; Amr S Albanna; Nehad N Al Shirawi; Siraj Wali; Khaled Alkattan; Abdulrahman A Alrajhi; Khalid Mobaireek; Hassan S Alorainy; Mohamed S Al-Hajjaj; Anne B Chang; Stefano Aliberti Journal: Ann Thorac Med Date: 2017 Jul-Sep Impact factor: 2.219