title: Use of Management Pathways or Algorithms in Children With Chronic Cough: CHEST Guideline and Expert Panel Report.
abstract: BACKGROUND
  Using management algorithms or pathways potentially improves clinical outcomes. We undertook systematic reviews to examine various aspects in the generic approach (use of cough algorithms and tests) to the management of chronic cough in children (aged ≤ 14 years) based on key questions (KQs) using the Population, Intervention, Comparison, Outcome format.
  
  
  METHODS
  We used the CHEST Expert Cough Panel's protocol for the systematic reviews and the American College of Chest Physicians (CHEST) methodological guidelines and Grading of Recommendations Assessment, Development and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain the final grading.
  
  
  RESULTS
  Combining data from systematic reviews addressing five KQs, we found high-quality evidence that a systematic approach to the management of chronic cough improves clinical outcomes. Although there was evidence from several pathways, the highest evidence was from the use of the CHEST approach. However, there was no or little evidence to address some of the KQs posed.
  
  
  CONCLUSIONS
  Compared with the 2006 Cough Guidelines, there is now 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 testing algorithms should differ depending on the associated characteristics of the cough and clinical history. A chest radiograph and, when age appropriate, spirometry (pre- and post-β2agonist) should be undertaken. Other tests should not be routinely performed and undertaken in accordance with the clinical setting and the child's clinical symptoms and signs (eg, tests for tuberculosis when the child has been exposed).
authors.affiliation: Menzies School of Health Research, Respiratory Department, Lady Cilento Children's Hospital, and Queensland University of Technology, QLD, Australia. Electronic address: annechang@ausdoctors.net.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
authors.affiliation: New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, 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 M
authors.initials: MM
authors.lastname: Weinberger
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: Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Weir
authors.affiliation: Department of Paediatrics, Child and Youth Health, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Cameron C
authors.initials: CC
authors.lastname: Grant
authors.affiliation: 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 / Q000628:therapy*; D003697:Delphi Technique; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans
keywords: cough; evidence-based medicine; guidelines; pediatrics