Children with chronic wet or productive cough-Treatment and investigations

Anne Chang, JJ Oppenheimer, M Weinberger, Bruce Rubin, Richard Irwin

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks’ duration) wet or productive cough not related to bronchiectasis: KQ1—How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2—When should they be referred for further investigations?
Methods: The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English.
Results: Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95% CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations.
Conclusions: There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks’ duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.
Original languageEnglish
Pages (from-to)120-142
Number of pages23
JournalChest
Volume149
Issue number1
DOIs
Publication statusPublished - 2016

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Cough
Randomized Controlled Trials
Retrospective Studies
Prospective Studies
Anti-Bacterial Agents
Therapeutics
Software Design
Numbers Needed To Treat
Bronchiectasis
Bronchoscopy
Meta-Analysis
Immunity
Thorax
Cross-Sectional Studies
Lung

Cite this

Chang, A., Oppenheimer, JJ., Weinberger, M., Rubin, B., & Irwin, R. (2016). Children with chronic wet or productive cough-Treatment and investigations. Chest, 149(1), 120-142. https://doi.org/10.1378/chest.15-2065
Chang, Anne ; Oppenheimer, JJ ; Weinberger, M ; Rubin, Bruce ; Irwin, Richard. / Children with chronic wet or productive cough-Treatment and investigations. In: Chest. 2016 ; Vol. 149, No. 1. pp. 120-142.
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abstract = "Background: Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks’ duration) wet or productive cough not related to bronchiectasis: KQ1—How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2—When should they be referred for further investigations?Methods: The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English.Results: Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95{\%} CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations.Conclusions: There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks’ duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.",
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Chang, A, Oppenheimer, JJ, Weinberger, M, Rubin, B & Irwin, R 2016, 'Children with chronic wet or productive cough-Treatment and investigations', Chest, vol. 149, no. 1, pp. 120-142. https://doi.org/10.1378/chest.15-2065

Children with chronic wet or productive cough-Treatment and investigations. / Chang, Anne; Oppenheimer, JJ; Weinberger, M; Rubin, Bruce; Irwin, Richard.

In: Chest, Vol. 149, No. 1, 2016, p. 120-142.

Research output: Contribution to journalArticleResearchpeer-review

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N2 - Background: Systematic reviews were conducted to examine two related key questions (KQs) in children with chronic (> 4 weeks’ duration) wet or productive cough not related to bronchiectasis: KQ1—How effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? KQ2—When should they be referred for further investigations?Methods: The systematic reviews were undertaken based on the protocol established by selected members of the CHEST expert cough panel. Two authors screened searches and selected and extracted data. The study included systematic reviews, randomized controlled trials (RCTs), cohort (prospective and retrospective) studies, and cross-sectional studies published in English.Results: Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowcharts, and the summaries were tabulated. Fifteen studies were included in KQ1 (three systematic reviews, three RCTs, five prospective studies, and four retrospective studies) and 17 in KQ2 (one RCT, 11 prospective studies, and five retrospective studies). Combining data from the RCTs (KQ1), the number needed to treat for benefit was 3 (95% CI, 2.0-4.3) in achieving cough resolution. In general, findings from prospective and retrospective studies were consistent, but there were minor variations.Conclusions: There is high-quality evidence that in children aged ≤ 14 years with chronic (> 4 weeks’ duration) wet or productive cough, the use of appropriate antibiotics improves cough resolution. There is also high-quality evidence that when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be conducted. When the wet cough does not improve by 4 weeks of antibiotic treatment, there is moderate-quality evidence that children should be referred to a major center for further investigations to determine whether an underlying lung or other disease is present.

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