CHEST Guidelines-Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis

Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis

Pdf Summary

The 2017 CHEST Guideline and Expert Panel Report focuses on managing chronic wet cough and protracted bacterial bronchitis (PBB) in children under 14 years. Wet cough, synonymous with productive cough in children, signals potential chronic respiratory issues. Reviewed evidence now strongly supports the use of antibiotics to resolve chronic wet cough, emphasizing the importance of selecting antibiotics based on common respiratory pathogens and local sensitivities. <br /><br />Key findings in high-quality systematic reviews indicate that a two-week course of antibiotics is generally effective for children who do not display specific cough pointers, such as digital clubbing. If the cough persists, additional two weeks of treatment is recommended. Should coughing continue beyond four weeks, or if specific symptoms arise, further investigations, such as flexible bronchoscopy or chest CT scans, are advised to explore possible underlying conditions.<br /><br />The guidelines introduce new terminology like 'microbiologically-based-PBB' where sputum tests confirm significant bacterial presence, as opposed to 'clinically-based-PBB' diagnosed without bacterial confirmation. The distinction aids in precise clinical evaluation and treatment personalization.<br /><br />Despite significant advancements since the 2006 CHEST guidelines, gaps persist, particularly in the primary care context. Most existing evidence derives from hospital settings, highlighting a need for further studies in diverse clinical environments. Suggested research directions include multicenter trials to gauge antibiotic treatment efficacy and duration, exploring cough outcomes in primary care, and addressing prevention of PBB recurrence.<br /><br />This updated framework supports clinicians in effectively diagnosing and treating chronic wet cough in children, ensuring interventions are backed by the latest evidence. However, further research is essential to refine primary health care practices and outcomes.

Keywords

chronic wet cough

protracted bacterial bronchitis

children under 14

antibiotic treatment

respiratory pathogens

systematic reviews

microbiologically-based PBB

clinically-based PBB

primary care

CHEST guidelines