CHEST Guidelines-Use of Management Pathways or Algorithms in Children With Chronic Cough

Use of Management Pathways or Algorithms in Children With Chronic Cough

Pdf Summary

The CHEST Guideline and Expert Panel Report addresses the management of chronic cough in children aged 14 years or younger, emphasizing the use of management pathways or algorithms to improve clinical outcomes. Chronic cough, defined as a daily cough lasting more than four weeks, can indicate serious underlying conditions, and early diagnosis is crucial to avoid long-term respiratory morbidity. <br /><br />Key findings from systematic reviews reveal high-quality evidence supporting the use of cough management protocols, such as those developed by the American College of Chest Physicians (ACCP), which highlight a systematic approach to diagnosis based on cough characteristics and clinical history. The guidelines recommend specific diagnostic strategies, including taking chest radiographs and conducting spirometry, to ascertain the cause of the cough when age-appropriate.<br /><br />The report advises against routinely performing extensive additional tests unless indicated by clinical circumstances, thereby individualizing care based on the child’s symptoms and setting. For suspected asthma, tests for airway hyperresponsiveness may be considered, particularly for children aged six years and older.<br /><br />The guideline reinforces the significant disease burden caused by chronic cough, emphasizing the need for considering the impact on a child's quality of life and the broader family context during clinical assessments. The evidence suggests that cough management should not rely on empirical treatment for conditions like upper airway cough syndrome, gastroesophageal reflux disease, or asthma, unless other supportive indications are present.<br /><br />Future research is encouraged to improve cough management, examining outcomes in primary care settings and evaluating whether cough management practices should adapt based on cough duration or severity. The recommendations aim to refine current guidelines with an evidence-based approach, supporting health professionals in diagnosing and managing chronic cough effectively.

Keywords

chronic cough

children

management pathways

clinical outcomes

diagnostic strategies

American College of Chest Physicians

spirometry

asthma

quality of life

evidence-based approach