CHEST Guidelines-Managing Chronic Cough as a Symptom in Children and Management Algorithms

Managing Chronic Cough as a Symptom in Children and Management Algorithms

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In the updated CHEST guidelines for managing chronic cough in children, chronic cough is defined as a daily cough lasting more than four weeks. It's emphasized that the causes and management strategies for chronic cough in children differ distinctly from those observed in adults. For children under 14 with chronic cough, management should follow pediatric-specific guidelines, employing systematic approaches using cough management protocols or algorithms tailored to individual histories and cough characteristics.<br /><br />Key recommendations include conducting a thorough clinical assessment and, when age-appropriate, performing a chest radiograph and spirometry. Further investigations such as bronchoscopy or chest CT should be individualized and based on specific clinical settings or symptoms.<br /><br />Treatment should be etiology-based, with a focus on addressing exacerbating factors like environmental tobacco smoke. Notably, empirical therapies targeting gastroesophageal reflux disease or asthma should not be used unless specific symptoms warrant such interventions.<br /><br />The guidelines underscore the criticality of differentiating between various causes, such as wet or productive cough—which may respond to antibiotics targeting common respiratory bacteria—and those linked to serious underlying conditions like aspiration or bronchiectasis, which necessitate more extensive investigations.<br /><br />Additionally, non-specific cough may resolve spontaneously or with specific targeted treatments like inhaled corticosteroids in the presence of asthma risk factors. Importantly, the use of over-the-counter cough medicines is discouraged without proven efficacy.<br /><br />Ongoing follow-ups are crucial to reassess and adjust treatment strategies based on the child's response, ensuring that any therapeutic trial is of limited duration to confirm or refute initial diagnoses. Understanding and addressing parental expectations and concerns is also emphasized in enhancing the management and quality of life of both the child and the family. Despite advances, the guideline notes gaps in high-quality evidence, particularly regarding non-specific cough management, indicating a need for further research.

Keywords

chronic cough

children

CHEST guidelines

pediatric-specific

etiology-based treatment

clinical assessment

cough management protocols

environmental tobacco smoke

differentiating causes

parental expectations