title: Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report.
abstract: BACKGROUND
  Wet or productive cough is common in children with chronic cough. We formulated recommendations based on systematic reviews related to the management of chronic wet cough in children (aged ≤ 14 years) based on two key questions: (1) how effective are antibiotics in improving the resolution of cough? If so, what antibiotic should be used and for how long? and (2) when should children be referred for further investigations?
  
  
  METHODS
  We used the CHEST expert cough panel's protocol for systematic reviews and the American College of Chest Physicians (CHEST) methodologic guidelines and GRADE framework (the Grading of Recommendations Assessment, Development and Evaluation). 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 consensus for the recommendations/suggestions made.
  
  
  RESULTS
  Combining data from the systematic reviews, we found high-quality evidence in children aged ≤ 14 years with chronic (> 4 weeks' duration) wet/productive cough that using appropriate antibiotics improves cough resolution, and further investigations (eg, flexible bronchoscopy, chest CT scans, immunity tests) should be undertaken when specific cough pointers (eg, digital clubbing) are present. When the wet cough does not improve following 4 weeks of antibiotic treatment, there is moderate-quality evidence that further investigations should be considered to look for an underlying disease. New recommendations include the recognition of the clinical diagnostic entity of protracted bacterial bronchitis.
  
  
  CONCLUSIONS
  Compared with the 2006 Cough Guidelines, there is now high-quality evidence for some, but not all, aspects of the management of chronic wet cough in specialist settings. However, further studies (particularly in primary health) are required.
authors.affiliation: Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; 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, 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: 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: Griffith University, Gold Coast, QLD, Australia.
authors.forename: Kelly
authors.initials: K
authors.lastname: Weir
authors.affiliation: UMass Memorial Medical Center, Worcester, MA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Irwin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001991:Bronchitis / Q000188:drug therapy* / Q000382:microbiology*; D002648:Child; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy* / Q000382:microbiology*; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents
keywords: children; cough; evidence-based; guidelines; management