CHEST Guidelines-Clinically-Diagnosing-Pertussis-associated-Cough-i (1)

Clinically-Diagnosing-Pertussis-associated-Cough-i (1)

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The CHEST guideline focuses on diagnosing pertussis-associated cough in adults and children. Pertussis or whooping cough is a contagious respiratory infection that can lead to significant morbidity, especially in young infants. Due to the necessity for timely antibiotic treatment to prevent the spread of the disease, clinical diagnosis often precedes laboratory confirmation. The guideline emphasizes diagnosing pertussis based on clinical features rather than waiting for laboratory results.<br /><br />For adults with an acute cough (less than three weeks) or subacute cough (3-8 weeks), the guideline suggests assessing four key characteristics: paroxysmal cough, posttussive vomiting, inspiratory whooping, and absence of fever. High sensitivity but low specificity was noted for paroxysmal cough and absence of fever, making their presence indicative of pertussis but their absence unlikely. Conversely, inspiratory whooping and posttussive vomiting have low sensitivity but high specificity, so their presence strongly suggests pertussis.<br /><br />For children, the guideline recommends evaluating paroxysmal cough, posttussive vomiting, and inspiratory whooping. However, posttussive vomiting in children was only moderately accurate as a diagnostic feature. In children with an acute cough lasting up to four weeks, posttussive vomiting alone hints at pertussis, while paroxysmal cough or inspiratory whooping can also suggest it.<br /><br />The recommendations are based on a systematic review and meta-analysis conducted on evidence from various databases. Studies were screened to ensure quality before inclusion in the analysis. The findings inform clinical practice by helping clinicians differentiate pertussis from other causes of cough, promoting timely management of this infectious disease.<br /><br />The guideline also identifies areas needing further research, including additional large prospective studies on patients with acute or subacute cough, particularly to fill knowledge gaps in younger populations.

Keywords

pertussis

whooping cough

diagnosis

antibiotic treatment

paroxysmal cough

posttussive vomiting

inspiratory whooping

clinical features

systematic review

infectious disease