title: Use of Management Pathways or Algorithms in Children With Chronic Cough: Systematic Reviews.
abstract: BACKGROUND
  Use of appropriate cough pathways or algorithms may reduce the morbidity of chronic cough, lead to earlier diagnosis of chronic underlying illness, and reduce unnecessary costs and medications. We undertook three systematic reviews to examine three related key questions (KQ): In children aged ?14 years with chronic cough (> 4 weeks' duration), KQ1, do cough management protocols (or algorithms) improve clinical outcomes? KQ2, should the cough management or testing algorithm differ depending on the duration and/or severity? KQ3, should the cough management or testing algorithm differ depending on the associated characteristics of the cough and clinical history?
  
  
  METHODS
  We used the CHEST expert cough panel's protocol. Two authors screened searches and selected and extracted data. Only systematic reviews, randomized controlled trials (RCTs), and cohort studies published in English were included.
  
  
  RESULTS
  Data were presented in Preferred Reporting Items for Systematic Reviews and Meta-analyses flowcharts and summary tabulated. Nine studies were included in KQ1 (RCT = 1; cohort studies = 7) and eight in KQ3 (RCT = 2; cohort = 6), but none in KQ2.
  
  
  CONCLUSIONS
  There is high-quality evidence that in children aged ?14 years with chronic cough (> 4 weeks' duration), the use of cough management protocols (or algorithms) improves clinical outcomes and cough management or the testing algorithm should differ depending on the associated characteristics of the cough and clinical history. It remains uncertain whether the management or testing algorithm should depend on the duration or severity of chronic cough. Pending new data, chronic cough in children should be defined as > 4 weeks' duration and children should be systematically evaluated with treatment targeted to the underlying cause irrespective of the cough severity.
authors.affiliation: Menzies School of Health Research; and Respiratory Deptartment, Lady Cilento Children's Hospital, Queensland University of Technology, Queensland, Australia. Electronic address: annechang@ausdoctors.net.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: Division of Allergy and Immunology, UMDNJ-New Jersey Medical School, Cedar Knolls, NJ.
authors.forename: John J
authors.initials: JJ
authors.lastname: Oppenheimer
authors.affiliation: Pediatric Allergy, Immunology, and Pulmonology Division, University of Iowa Children's Hospital, Iowa City, IA.
authors.forename: Miles
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Speech Pathology Deptartment, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Weir
authors.affiliation: Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA.
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Rubin
authors.affiliation: Division of Pulmonary, Allergy & Critical Care Medicine, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D000293:Adolescent; D000465:Algorithms; D002648:Child; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019091:Critical Pathways; D019468:Disease Management; D006801:Humans
keywords: children; cough; guidelines; systematic review