CHEST Guidelines-Chronic Cough and Gastroesophageal Reflux in Children

Chronic Cough and Gastroesophageal Reflux in Children

Pdf Summary

The report titled "Chronic Cough and Gastroesophageal Reflux in Children" from the CHEST Expert Cough Panel examines the contentious issue of whether gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD) causes chronic cough in children. Chronic cough is defined as lasting more than four weeks, not associated with underlying lung disease. The panel used a systematic review approach based on the Population, Intervention, Comparison, Outcome (PICO) framework, assessing whether GERD treatment should be used in children with or without GER symptoms.<br /><br />Key findings include:<br /><br />1. GERD treatment should not be used for children lacking GER symptoms like regurgitation or heartburn.<br />2. GERD treatment might be considered in children showing GER symptoms, but should adhere to GERD-specific guidelines.<br />3. Empirical GERD treatment should not solely aim to resolve chronic cough.<br />4. For children with GER symptoms, a 4-8 week trial of GERD-focused treatment is suggested, not exceeding this period without reevaluation.<br />5. Diagnosis and investigation of suspected GERD-related cough should follow established guidelines, largely considering GERD symptoms.<br /><br />The report highlighted the scarcity of research trials investigating GERD's impact on pediatric chronic cough and noted that current guidelines do not support widespread use of GERD treatments for cough absent of symptomatic reflux indications. It emphasizes treatments should be patient-specific, dependent on the age, symptoms, and feeding regimen.<br /><br />Additionally, serious potential risks associated with prolonged proton pump inhibitor use, such as infections and nutritional deficiencies, caution against routine GERD treatments without confirmed benefits in chronic cough cases. Future research directions should include robust trials targeting specific populations with GERD and cough to assess treatment efficacy and safety.  <br /><br />The CHEST report thus advocates for clinical prudence and systematic utilization of evidence-based guidelines when addressing chronic cough in pediatric patients potentially related to GERD.

Keywords

chronic cough

gastroesophageal reflux

GERD

children

CHEST Expert Cough Panel

systematic review

PICO framework

GERD treatment

proton pump inhibitors

pediatric guidelines