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

{"article_title":"Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report.","author":"Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, Irwin RS","journal_title":"Chest","issn":"1931-3543","isbn":"","publication_date":"2017-04-01","volume":"151","issue":"4","first_page":"884","page_count":"","accession_number":"28143696","doi":"10.1016\/j.chest.2017.01.025","publisher":"Elsevier","doctype":"Journal Article","subjects":"Anti-Bacterial Agents therapeutic use; Bronchitis drug therapy; Bronchitis microbiology; Cough drug therapy; Cough microbiology; Child; Chronic Disease; Delphi Technique; Evidence-Based Medicine; Humans","interest_area":["Pulmonology"," Pediatric Medicine"],"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 \u2264 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 \u2264 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. Copyright \u00a9 2017 American College of Chest Physicians. All rights reserved.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=28143696","isPdfLink":false,"isSAML":false,"an":"28143696","number_other":"","type_pub":"","issn_electronic":"1931-3543","languages":"English","language":"eng","date_entry":"Date Created: 20170202 Date Completed: 20170515 Latest Revision: 20170515","date_update":"20240105","titleSource":"Chest [Chest] 2017 Apr; Vol. 151 (4), pp. 884-890. Date of Electronic Publication: 2017 Jan 28.","date_pub_cy":"","type_document":"","contract_publisher":"","authored_on":"2017-04-01","description":"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 \u2264 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?<br \/>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.<br \/>Results: Combining data from the systematic reviews, we found high-quality evidence in children aged \u2264 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.<br \/>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.<br \/> (Copyright © 2017 American College of Chest Physicians. All rights reserved.)","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&scope=site&db=mdl&AN=28143696&authtype=shib&custid=ns346513&group=main&profile=eds","no_of_pages":"","authored_by":"Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, Irwin RS"}