A Cough Algorithm for Chronic Cough in Children: A Multicenter, Randomized Controlled Study

Anne Chang; Colin F Robertson; Peter Van Asperen; Nicholas Glasgow; Ian Brent Masters; Laurel Choon-Seow Teoh; Craig M Mellis; Louis Landau; Julie Marchant; Peter Morris

doi:10.1542/peds.2012-3318

A Cough Algorithm for Chronic Cough in Children: A Multicenter, Randomized Controlled Study

Anne Chang, Colin F Robertson, Peter Van Asperen, Nicholas Glasgow, Ian Brent Masters, Laurel Choon-Seow Teoh, Craig M Mellis, Louis Landau, Julie Marchant, Peter Morris

Child and Maternal Health

Research output: Contribution to journal › Article › peer-review

105 Citations (Scopus)

Abstract

Objectives: The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children.

Methods: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm’s reliability, validity, and feasibility.

Results: Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13–35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29–1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm’s validity (93%–100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care.

Conclusions: Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.

Original language	English
Pages (from-to)	e1576-e1583
Number of pages	8
Journal	Pediatrics
Volume	131
Issue number	5
DOIs	https://doi.org/10.1542/peds.2012-3318
Publication status	Published - May 2013

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title = "A Cough Algorithm for Chronic Cough in Children: A Multicenter, Randomized Controlled Study",

abstract = "Objectives: The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. Methods: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm{\textquoteright}s reliability, validity, and feasibility. Results: Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13–35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29–1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm{\textquoteright}s validity (93%–100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care. Conclusions: Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.",

keywords = "algorithm, article, asthma, atelectasis, bronchiectasis, bronchitis, child, chronic cough, controlled study, cough algorithm, cystic fibrosis, disease duration, feasibility study, female, follow up, health care management, human, lung disease, lung fibrosis, major clinical study, male, multicenter study, mycoplasmosis, outcome assessment, pertussis, practice guideline, preschool child, primary medical care, priority journal, quality of life, randomized controlled trial, reliability, respiratory tract disease, tracheobronchomalacia, validity, children, cough, guidelines, Algorithms, Australia, Case Management, Child, Child, Preschool, Chronic Disease, Combined Modality Therapy, Cough, Critical Pathways, Early Diagnosis, Female, Follow-Up Studies, Humans, Infant, Male, Primary Health Care, Reproducibility of Results, Risk Assessment, Severity of Illness Index, Treatment Outcome",

author = "Anne Chang and Robertson, {Colin F} and {Van Asperen}, Peter and Nicholas Glasgow and Masters, {Ian Brent} and Teoh, {Laurel Choon-Seow} and Mellis, {Craig M} and Louis Landau and Julie Marchant and Peter Morris",

year = "2013",

month = may,

doi = "10.1542/peds.2012-3318",

language = "English",

volume = "131",

pages = "e1576--e1583",

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T1 - A Cough Algorithm for Chronic Cough in Children

T2 - A Multicenter, Randomized Controlled Study

AU - Chang, Anne

AU - Robertson, Colin F

AU - Van Asperen, Peter

AU - Glasgow, Nicholas

AU - Masters, Ian Brent

AU - Teoh, Laurel Choon-Seow

AU - Mellis, Craig M

AU - Landau, Louis

AU - Marchant, Julie

AU - Morris, Peter

PY - 2013/5

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N2 - Objectives: The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. Methods: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm’s reliability, validity, and feasibility. Results: Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13–35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29–1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm’s validity (93%–100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care. Conclusions: Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.

AB - Objectives: The goals of this study were to: (1) determine if management according to a standardized clinical management pathway/algorithm (compared with usual treatment) improves clinical outcomes by 6 weeks; and (2) assess the reliability and validity of a standardized clinical management pathway for chronic cough in children. Methods: A total of 272 children (mean ± SD age: 4.5 ± 3.7 years) were enrolled in a pragmatic, multicenter, randomized controlled trial in 5 Australian centers. Children were randomly allocated to 1 of 2 arms: (1) early review and use of cough algorithm (“early-arm”); or (2) usual care until review and use of cough algorithm (“delayed-arm”). The primary outcomes were proportion of children whose cough resolved and cough-specific quality of life scores at week 6. Secondary measures included cough duration postrandomization and the algorithm’s reliability, validity, and feasibility. Results: Cough resolution (at week 6) was significantly more likely in the early-arm group compared with the delayed-arm group (absolute risk reduction: 24.7% [95% confidence interval: 13–35]). The difference between cough-specific quality of life scores at week 6 compared with baseline was significantly better in the early-arm group (mean difference between groups: 0.6 [95% confidence interval: 0.29–1.0]). Duration of cough postrandomization was significantly shorter in the early-arm group than in the delayed-arm group (P = .001). The cough algorithm was reliable (κ = 1 in key steps). Feasibility was demonstrated by the algorithm’s validity (93%–100%) and efficacy (99.6%). Eighty-five percent of children had etiologies easily diagnosed in primary care. Conclusions: Management of children with chronic cough, in accordance with a standardized algorithm, improves clinical outcomes irrespective of when it is implemented. Further testing of this standardized clinical algorithm in different settings is recommended.

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A Cough Algorithm for Chronic Cough in Children: A Multicenter, Randomized Controlled Study

Abstract

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