CHEST Guidelines-Use-of-Management-Pathways-or-Algorithms-in-Childr (2)

Use-of-Management-Pathways-or-Algorithms-in-Childr (2)

Pdf Summary

The CHEST Guideline and Expert Panel Report addresses the use of management pathways or algorithms in children with chronic cough, particularly focusing on those aged 14 years and under. Chronic cough in children is defined as a daily cough lasting at least four weeks. The report highlights that using cough management protocols or algorithms improves clinical outcomes, as supported by high-quality evidence from systematic reviews.<br /><br />Recommendations include using pediatric-specific cough management protocols or algorithms, undertaking a systematic approach to diagnose the cause of the cough, and basing management or testing on cough characteristics and clinical history. A chest radiograph and, where appropriate, spirometry should be part of the evaluation, but additional tests like bronchoscopy or CT scans should be individualized based on specific symptoms and clinical settings.<br /><br />The report emphasizes that cough management should differ based on associated characteristics and clinical history, steering away from an empirical approach unless consistent features with conditions such as asthma, rhinosinus disease, or GERD are present. Testing for conditions like recent Bordetella pertussis infection is suggested when clinical suspicion arises.<br /><br />Furthermore, the document encourages an assessment of the impact of cough on both the child and the family during clinical consultations. It also suggests that further research is required in areas such as cough algorithm efficacy in various clinical settings, the risk-benefit ratio of using different chronic cough durations, and the need for additional studies on advanced pulmonary function tests like testing for airway hyperresponsiveness in children with suspected asthma.<br /><br />Overall, a refined, empirically-backed approach tailored to individual characteristics and evidence is advocated to manage chronic cough effectively in pediatric populations.

Keywords

chronic cough

children

management pathways

pediatric

cough algorithms

clinical outcomes

systematic reviews

diagnosis

cough characteristics

evidence-based