Chest
Volume 152, Issue 3, September 2017, Pages 607-617
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Evidence-Based Medicine
Etiologies of Chronic Cough in Pediatric Cohorts: CHEST Guideline and Expert Panel Report

https://doi.org/10.1016/j.chest.2017.06.006Get rights and content

Background

There is no published systematic review on the etiologies of chronic cough or the relationship between OSA and chronic cough in children aged ≤ 14 years. We thus undertook a systematic review based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format. The KQs follow: Among children with chronic (> 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children?

Methods

We used the CHEST Expert Cough Panel’s protocol 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 consensus.

Results

Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent. Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies.

Conclusions

There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.

Section snippets

Summary of Recommendations and Suggestions

1. For children aged ≤ 14 years, we recommend that common etiologies of chronic cough in adults are not presumed to be common causes in children (Level 1B).

2. For children aged ≤ 14 years with chronic cough, we recommend that their age and the clinical settings (eg, country and region) are taken into consideration when evaluating and managing their chronic cough (Level 1B).

3. For children aged ≤ 14 years with chronic cough, we suggest that clinical studies aimed at evaluating cough etiologies

Methods

We undertook the systematic reviews based on the protocol16 established by selected members of the CHEST Expert Cough Panel. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting. The KQs were framed by this paper’s main authors.

Results

The search results and PRISMA diagrams for all KQs are presented in e-Figures 1 and 2.

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. C. was an author of several of the papers included in this review, is an author and reviewer for Up to Date, was on the data safety monitoring board for a vaccine study (Glaxo), and has been an advisor for the study design of an unlicensed product (Merck). J. J. O. is on the Board of Directors for the American Board of Allergy and Immunology, is associate editor for the Annals of Allergy Watch, has been

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    DISCLAIMER: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://www.chestnet.org/Guidelines-and-Resources/Guidelines-and-Consensus-Statements/CHEST-Guidelines.

    FUNDING/SUPPORT: A. B. C. is supported by a National Health and Medical Research Council (NHMRC) practitioner fellowship [Grant 1058213] and holds multiple grants awarded from the NHMRC related to diseases associated with pediatric cough. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC.

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