CHEST Guidelines-Use-of-Management-Pathways-or-Algorithms-in-Childr (1)

Use-of-Management-Pathways-or-Algorithms-in-Childr (1)

Pdf Summary

The CHEST Guideline and Expert Panel Report examines the use of management pathways or algorithms in treating chronic cough in children aged 14 and under, seeking to improve clinical outcomes. The report is founded on systematic reviews addressing key questions related to assessing and managing chronic cough, using the PICO (Population, Intervention, Comparison, Outcome) format. It confirms high-quality evidence that adopting a systematic approach, such as the CHEST-guided pathway, significantly enhances clinical outcomes compared to other algorithms.<br /><br />The guideline emphasizes defining chronic cough in children as a cough persisting for at least four weeks. It recommends using pediatric-specific management protocols and stresses the importance of basing management strategies on cough characteristics and clinical history, rather than empirical treatments, unless specific features like gastroesophageal reflux or asthma are indicated. Regular investigations should include chest radiographs and appropriate spirometry. Additional tests should be guided by clinical symptoms rather than routine procedures.<br /><br />The document reflects advancements since the 2006 guidelines, providing a comprehensive evidence-based framework for assessing chronic cough in pediatric populations. Key recommendations include:<br />1. Defining chronic cough in children as daily cough lasting over four weeks.<br />2. Assessing the impact of the cough on the child's quality of life and family.<br />3. Employing pediatric-specific cough management protocols.<br />4. Basing management on the cough's etiology and using targeted tests rather than empirical treatments.<br /><br />Despite strong evidence supporting some recommendations, the report highlights gaps, particularly in primary care settings, and urges further research. It suggests future studies to assess outcomes of acute cough turning chronic, the efficacy of management in primary care settings, and the benefits of using specific algorithms in various healthcare environments. The guidelines also recommend a distinction between pediatric and adult chronic cough definitions and approaches.

Keywords

chronic cough

children

management pathways

clinical outcomes

PICO format

pediatric-specific protocols

systematic reviews

evidence-based framework

primary care

future research