CHEST Guidelines-Use-of-Management-Pathways-or-Algorithms-in-Childr

Use-of-Management-Pathways-or-Algorithms-in-Childr

Pdf Summary

The CHEST Guideline and Expert Panel Report of 2017 provides detailed recommendations for managing chronic cough in children under 14. It emphasizes the significant benefits of using management pathways or algorithms tailored specifically for pediatric cases. Chronic cough, defined as a daily cough lasting over four weeks, can substantially impact the quality of life and may indicate serious underlying health issues, such as bronchiectasis or an inhaled foreign body.<br /><br />The guidelines recommend a systematic approach, utilizing pediatric-specific protocols and cough management pathways to improve clinical outcomes. High-quality evidence suggests these protocols are effective in diagnosing and managing chronic cough in children. Key recommendations include undertaking a chest radiograph and spirometry (if age-appropriate) for children with chronic cough while limiting other tests unless clinically indicated. Specific indicators such as the presence of a wet cough may dictate the management or testing pathways.<br /><br />Furthermore, the guidelines advise against routine empirical treatment for conditions like rhinosinusitis or gastroesophageal reflux unless symptoms strongly suggest these diagnoses. The use of a structured evaluation is advised, including an assessment of the cough's impact on the child's and family's life, which often goes overlooked.<br /><br />A crucial part of the guideline is the emphasis on individualized decision-making based on clinical presentation and history, rather than a one-size-fits-all approach. This includes recommending tests for conditions like pertussis only when clinically suspected.<br /><br />Overall, while emphasizing evidence-based practices, the report acknowledges existing gaps in knowledge, particularly in primary care settings, and suggests further research to continue improving management strategies for chronic cough in children. The systematic, evidence-based methodology aims to foster earlier diagnosis, reduce unnecessary interventions, and improve patient outcomes while minimizing risks and costs associated with chronic pediatric cough management.

Keywords

chronic cough

children

pediatric

guidelines

management pathways

evidence-based

diagnosis

chest radiograph

spirometry

individualized decision-making