CHEST Guidelines-Chronic-Cough-and-Gastroesophageal-Reflux-in-Child

Chronic-Cough-and-Gastroesophageal-Reflux-in-Child

Pdf Summary

The CHEST Guideline and Expert Panel Report investigates the relationship between chronic cough and gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) in children. Chronic cough, defined as lasting more than four weeks, is a frequent concern due to its impact on children's quality of life and its burdensome nature for both children and parents. The association of GERD with chronic cough is well-recognized in adults, but the causal link in children remains controversial and less understood.<br /><br />The report uses the Population, Intervention, Comparison, Outcome (PICO) framework to perform systematic reviews focused on four key questions (KQs). These involve determining if GERD treatments should be used empirically, whether GERD treatments can resolve chronic cough, what GERD-based therapies are suitable, and which diagnostic criteria effectively identify GERD as the cause of cough.<br /><br />The findings indicate that empirical treatment for GERD should not be applied in the absence of GER symptoms, such as regurgitation or heartburn, in children with chronic cough. For those exhibiting GER symptoms, treatment should follow evidence-based GERD-specific guidelines, but acid suppressants like proton pump inhibitors (PPIs) should not be solely used for cough due to potential adverse events. The report emphasizes that pediatric GERD guidelines should guide treatment and evaluations.<br /><br />There is a noted scarcity of high-level evidence supporting causality between GERD and chronic cough in children, and further research is encouraged. Specific areas of suggested research include targeted randomized controlled trials (RCTs) and delineation of optimal treatment durations. Overall, the guidelines provide structured recommendations primarily drawn from previous comprehensive pediatric GERD-specific guidelines, endorsed by frameworks like NICE and NASPGHAN/ESPGHAN.

Keywords

chronic cough

gastroesophageal reflux

GERD

children

PICO framework

treatment guidelines

proton pump inhibitors

randomized controlled trials

pediatric guidelines

quality of life