Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology
Main Article Content
Keywords
adolescents, algorithm, children, chronic cough, diagnosis, dry cough, wet cough
Abstract
The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.
Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to inter-professional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach.
Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family.
Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice.
References
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21. Khoshoo V, Edell D, Mohnot S, Haydel R Jr, Saturno E, Kobernick A. Associated factors in children with chronic cough. Chest. 2009;136(3):811–15. 10.1378/chest.09-0649
22. O’Grady KF, Drescher BJ, Goyal V, Phillips N, Acworth J, Marchant JM, et al. Chronic cough post-acute respiratory illness in children: A cohort study. Arch Dis Child. 2017;102(11):1044–8. 10.1136/archdischild-2017-312848
23. Usta Guc B, Asilsoy S, Dur Yilmaz C. The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: A descriptive, prospective, clinical trial. Clin Respir J. 2014;8(3):330–7. 10.1111/crj.12076
24. Yildiz Y, Igde M. Evaluation of fractioned nitric oxide in chronic cough patients. Niger J Clin Pract. 2018;21(1):1–6.
25. Zgherea D, Pagala S, Mendiratta M, Marcus MG, Shelov SP, Kazachkov M. Bronchoscopic findings in children with chronic wet cough. Pediatrics. 2012;129(2):e364–9. 10.1542/peds.2011-0805
26. Chang AB, Oppenheimer JJ, Irwin RS, CHEST Expert Cough Panel. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020; 158(1):303–329.
27. Hay AD, Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: A systematic review. Br J Gen Pract. 2002;52(478):401–9.
28. Kantar A, Bernardini R, Paravati F, Minasi D, Sacco O. Chronic cough in preschool children. Early Hum Dev. 2013;89:S19–24. 10.1016/j.earlhumdev.2013.07.018
29. Behan L, Dimitrov BD, Kuehni CE, Hogg C, Carroll M, Evans HJ, et al. PICADAR: A diagnostic, predictive tool for primary ciliary dyskinesia. Eur Respir J. 2016;47(4):1103–12. 10.1183/13993003.01551-2015
30. Sahin A, Meteroglu F, Eren S, Celik Y. Inhalation of foreign bodies in children: Experience of 22 years. J Trauma Acute Care Surg. 2013;74:658–63. 10.1097/TA.0b013e3182789520
31. Nadel JA. Mucus hypersecretion and relationship to cough. Pulm Pharmacol Ther. 2013;19(13):60–6.
32. Hallander HO, Gnarpe J, Gnarpe H. Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, and persistent cough in children. Scand J Infect Dis. 1999;31:281–6. 10.1080/00365549950163581
33. Braman SS. Postinfectious cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129(Suppl 1):138S–46S. 10.1378/chest.129.1_suppl.138S
34. Newcombe PA, Sheffield JK, Juniper EF, Petsky HL, Willis C, Chang AB. Validation of a parent-proxy quality of life questionnaire for pediatric chronic cough (PC-QOL). Thorax. 2010;65(9):819–23. 10.1136/thx.2009.133868
35. Davies MJ, Fuller P, Picciotto A, McKenzie SA. Persistent nocturnal cough: A randomized controlled trial of high dose inhaled corticosteroid. Arch Dis Child. 1999;81(1):38–44. 10.1136/adc.81.1.38
36. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R. British Thoracic Society Cough Guideline Group. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63(Suppl 3):1–15. 10.1136/thx.2007.077370
37. Vertigan AE, Murad MH, Pringsheim T, Feinstein A, Chang AB, Newcombe PA, et al. Somatic cough syndrome (previously referred to as psychogenic cough) and tic cough (previously referred to as habit cough) in adults and children: CHEST guideline and expert panel report. Chest. 2015;148(1):24–31. 10.1378/chest.15-0423
38. Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Turktas I. Children with chronic non-specific isolated cough. Chest. 2014;145(6):1279–85. 10.1378/chest.13-2348
39. Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, et al. Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST guideline and expert panel report. Chest. 2017;151(4):884–90. 10.1016/j.chest.2017.01.025
40. Marchant J, Masters IB, Champion A, Petsky H, Chang AB. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax. 2012;67(8):689–93. 10.1136/thoraxjnl-2011-201506
41. Eg KP, Mirra V, Chang AB, Santamaria F. Editorial: Chronic suppurative lung disease and bronchiectasis in children and adolescents. Front Pediatr. 2017;5:1–3. 10.3389/fped.2017.00196
42. Mansour-Ghanaie R, Fahimzad SA, Karimi A. Management of chronic cough in children. Arch Pediatr Infect Dis. 2013;1(3):136–43. 10.5812/pedinfect.11541
43. Ioannidis JP, Lau J. Technical report: Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: A systematic overview. Pediatrics. 2001;108(3):E57. 10.1542/peds.108.3.e57
44. Fitch PS, Brown V, Schock BC, Taylor R, Ennis M, Shields MD. Chronic cough in children: Bronchoalveolar lavage findings. Eur Respir J. 2000;16(6):1109–14. 10.1034/j.1399-3003.2000.16f15.x
45. Sadeghi MH, Wright CE, Hart S, Crooks M, Morice A. Phenotyping patients with chronic cough: Evaluating the ability to predict the response to anti-inflammatory therapy. Ann Allergy Asthma Immunol. 2018;120(3):285–91. 10.1016/j.anai.2017.12.004
46. Zhou J, Zhao X, Zhang X, Yu X, Wang Y, Jiang W, et al. Values of fractional exhaled nitric oxide for cough-variant asthma in children with chronic cough. J Thorac Dis. 2018;10(12):6616–23. 10.21037/jtd.2018.11.137
47. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516–54. 10.1097/MPG.0000000000001889
48. Burke JM, Jackson W, Morice AH. The role of high-resolution oesophageal manometry in occult respiratory symptoms. Respir Med. 2018;138:47–9. 10.1016/j.rmed.2018.03.027
49. Fracchia MS, Diercks G, Cook A, Hersh C, Hardy S, Hartnick M, et al. The diagnostic role of triple endoscopy in pediatric patients with chronic cough. Int J Pediatr Otorhinolaryngol. 2019;116:58–61. 10.1016/j.ijporl.2018.10.017
2. McGovern AE, Short KR, Kywe Moe AA, Mazzone SB. Translational review: Neuroimmune mechanisms in cough and emerging therapeutic targets. J Allergy Clin Immunol. 2018;142(5):1392–402. 10.1016/j.jaci.2018.09.004
3. Canning BJ, Chang AB, Bolser DC, Smith JA, Mazzone SB, McGarvey L, et al. Anatomy and neurophysiology of cough: CHEST Guideline and Expert Panel report. Chest. 2014;146(6):1633–48. 10.1378/chest.14-1481
4. Chung KF. The clinical and pathophysiological challenge of cough. In: Chung KF, Widdicombe JG, Boushey HA, editors. Cough: Causes, mechanisms, and therapy. Oxford, UK: Blackwell Publishing Ltd; 2003. p. 3-10. 10.1002/9780470755846
5. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(Suppl 1):260S–83S. 10.1378/chest.129.1_suppl.260S
6. Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J. 2020; 55(1):1901136. 10.1183/13993003.01136-2019
7. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration; 2011. www.cochrane-handbook.org
8. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009;62:e1–34. 10.1016/j.jclinepi.2009.06.006
9. Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children with chronic wet or productive cough–Treatment and investigations: A systematic review. Chest. 2016;149(1):120–42. 10.1378/chest.15-2065
10. Asilsoy S, Bayram E, Can D. Seroprevalence of chlamydia pneumoniae and mycoplasma pneumoniae in children with chronic cough. Asthma Allergy Immunol. 2015;13:3.
11. Cash H, Trosman S, Abelson T, Yellon R, Anne S. Chronic cough in children. JAMA Otolaryngol Head Neck Surg. 2015;141(5):417–23. 10.1001/jamaoto.2015.0257
12. Chang AB, Robertson CF, Van Asperen PP, Glasgow NJ, Mellis CM, Masters IB, et al. A multicenter study on chronic cough in children: Burden and etiologies based on a standardized management pathway. Chest. 2012;142(4):943–50. 10.1378/chest.11-2725
13. Chang AB, Van Asperen PP, Glasgow N, Robertson CF, Mellis CM, Masters IB, et al. Children with chronic cough: When is watchful waiting appropriate? Development of likelihood ratios for assessing children with chronic cough. Chest. 2015;147(3):745–53. 10.1378/chest.14-2155
14. Chang AB, Oppenheimer JJ, Weinberger M, Weir K, Rubin BK, Irwin RS. Use of management pathways or algorithms in children with chronic cough: Systematic reviews. Chest. 2016;149(1):106–19. 10.1378/chest.15-1403
15. Chen X, Peng WS, Wang L. Etiology analysis of non-specific chronic cough in children of 5 years and younger. Medicine (Baltimore). 2019;98(3):e13910. 10.1097/MD.0000000000013910
16. Gedik AH, Cakir E, Torun E, Demir AD, Kucukkoc M, Erenberk U, et al. Evaluation of 563 children with chronic cough accompanied by a new clinical algorithm. Ital J Pediatr. 2015;41:73. 10.1186/s13052-015-0180-0
17. Hare KM, Chang AB, Smith-Vaughan HC, Bauert PA, Spain B, Beissbarth J, et al. Do combine upper airway cultures identify lower airway infections in children with chronic cough? Pediatr Pulmonol. 2019;54(6):907–13. 10.1002/ppul.24336
18. Ilarslan NEC, Gunay F, Haskologlu ZS, Bal SK, Tezcaner ZC, Kirsaclioglu CT, et al. Evaluation of children with chronic cough including obstructive sleep apnea: A single-center experience. Eur J Pediatr. 2019;178(2):189–97. 10.1007/s00431-018-3276-x
19. Wilson NW, Hogan MB, Harper CB, Peele K, Budhecha S, Loffredo V, et al. Sinusitis and chronic cough in children. J Asthma Allergy. 2012;5:27–32. 10.2147/JAA.S31874
20. Karabel M, Kelekçi S, Karabel D, Gürkan MF. The evaluation of children with prolonged cough accompanied by American College of Chest Physicians guidelines. Clin Respir J. 2014;8(2):152–9. 10.1111/crj.12052
21. Khoshoo V, Edell D, Mohnot S, Haydel R Jr, Saturno E, Kobernick A. Associated factors in children with chronic cough. Chest. 2009;136(3):811–15. 10.1378/chest.09-0649
22. O’Grady KF, Drescher BJ, Goyal V, Phillips N, Acworth J, Marchant JM, et al. Chronic cough post-acute respiratory illness in children: A cohort study. Arch Dis Child. 2017;102(11):1044–8. 10.1136/archdischild-2017-312848
23. Usta Guc B, Asilsoy S, Dur Yilmaz C. The assessment and management of chronic cough in children according to the British Thoracic Society guidelines: A descriptive, prospective, clinical trial. Clin Respir J. 2014;8(3):330–7. 10.1111/crj.12076
24. Yildiz Y, Igde M. Evaluation of fractioned nitric oxide in chronic cough patients. Niger J Clin Pract. 2018;21(1):1–6.
25. Zgherea D, Pagala S, Mendiratta M, Marcus MG, Shelov SP, Kazachkov M. Bronchoscopic findings in children with chronic wet cough. Pediatrics. 2012;129(2):e364–9. 10.1542/peds.2011-0805
26. Chang AB, Oppenheimer JJ, Irwin RS, CHEST Expert Cough Panel. Managing chronic cough as a symptom in children and management algorithms: CHEST guideline and expert panel report. Chest. 2020; 158(1):303–329.
27. Hay AD, Wilson AD. The natural history of acute cough in children aged 0 to 4 years in primary care: A systematic review. Br J Gen Pract. 2002;52(478):401–9.
28. Kantar A, Bernardini R, Paravati F, Minasi D, Sacco O. Chronic cough in preschool children. Early Hum Dev. 2013;89:S19–24. 10.1016/j.earlhumdev.2013.07.018
29. Behan L, Dimitrov BD, Kuehni CE, Hogg C, Carroll M, Evans HJ, et al. PICADAR: A diagnostic, predictive tool for primary ciliary dyskinesia. Eur Respir J. 2016;47(4):1103–12. 10.1183/13993003.01551-2015
30. Sahin A, Meteroglu F, Eren S, Celik Y. Inhalation of foreign bodies in children: Experience of 22 years. J Trauma Acute Care Surg. 2013;74:658–63. 10.1097/TA.0b013e3182789520
31. Nadel JA. Mucus hypersecretion and relationship to cough. Pulm Pharmacol Ther. 2013;19(13):60–6.
32. Hallander HO, Gnarpe J, Gnarpe H. Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae, and persistent cough in children. Scand J Infect Dis. 1999;31:281–6. 10.1080/00365549950163581
33. Braman SS. Postinfectious cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129(Suppl 1):138S–46S. 10.1378/chest.129.1_suppl.138S
34. Newcombe PA, Sheffield JK, Juniper EF, Petsky HL, Willis C, Chang AB. Validation of a parent-proxy quality of life questionnaire for pediatric chronic cough (PC-QOL). Thorax. 2010;65(9):819–23. 10.1136/thx.2009.133868
35. Davies MJ, Fuller P, Picciotto A, McKenzie SA. Persistent nocturnal cough: A randomized controlled trial of high dose inhaled corticosteroid. Arch Dis Child. 1999;81(1):38–44. 10.1136/adc.81.1.38
36. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R. British Thoracic Society Cough Guideline Group. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63(Suppl 3):1–15. 10.1136/thx.2007.077370
37. Vertigan AE, Murad MH, Pringsheim T, Feinstein A, Chang AB, Newcombe PA, et al. Somatic cough syndrome (previously referred to as psychogenic cough) and tic cough (previously referred to as habit cough) in adults and children: CHEST guideline and expert panel report. Chest. 2015;148(1):24–31. 10.1378/chest.15-0423
38. Yilmaz O, Bakirtas A, Ertoy Karagol HI, Topal E, Turktas I. Children with chronic non-specific isolated cough. Chest. 2014;145(6):1279–85. 10.1378/chest.13-2348
39. Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, et al. Management of children with chronic wet cough and protracted bacterial bronchitis: CHEST guideline and expert panel report. Chest. 2017;151(4):884–90. 10.1016/j.chest.2017.01.025
40. Marchant J, Masters IB, Champion A, Petsky H, Chang AB. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax. 2012;67(8):689–93. 10.1136/thoraxjnl-2011-201506
41. Eg KP, Mirra V, Chang AB, Santamaria F. Editorial: Chronic suppurative lung disease and bronchiectasis in children and adolescents. Front Pediatr. 2017;5:1–3. 10.3389/fped.2017.00196
42. Mansour-Ghanaie R, Fahimzad SA, Karimi A. Management of chronic cough in children. Arch Pediatr Infect Dis. 2013;1(3):136–43. 10.5812/pedinfect.11541
43. Ioannidis JP, Lau J. Technical report: Evidence for the diagnosis and treatment of acute uncomplicated sinusitis in children: A systematic overview. Pediatrics. 2001;108(3):E57. 10.1542/peds.108.3.e57
44. Fitch PS, Brown V, Schock BC, Taylor R, Ennis M, Shields MD. Chronic cough in children: Bronchoalveolar lavage findings. Eur Respir J. 2000;16(6):1109–14. 10.1034/j.1399-3003.2000.16f15.x
45. Sadeghi MH, Wright CE, Hart S, Crooks M, Morice A. Phenotyping patients with chronic cough: Evaluating the ability to predict the response to anti-inflammatory therapy. Ann Allergy Asthma Immunol. 2018;120(3):285–91. 10.1016/j.anai.2017.12.004
46. Zhou J, Zhao X, Zhang X, Yu X, Wang Y, Jiang W, et al. Values of fractional exhaled nitric oxide for cough-variant asthma in children with chronic cough. J Thorac Dis. 2018;10(12):6616–23. 10.21037/jtd.2018.11.137
47. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516–54. 10.1097/MPG.0000000000001889
48. Burke JM, Jackson W, Morice AH. The role of high-resolution oesophageal manometry in occult respiratory symptoms. Respir Med. 2018;138:47–9. 10.1016/j.rmed.2018.03.027
49. Fracchia MS, Diercks G, Cook A, Hersh C, Hardy S, Hartnick M, et al. The diagnostic role of triple endoscopy in pediatric patients with chronic cough. Int J Pediatr Otorhinolaryngol. 2019;116:58–61. 10.1016/j.ijporl.2018.10.017
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Mar 1, 2021
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Marseglia, G. L., Manti, S., Chiappini, E., Brambilla, I., Caffarelli, C., Calvani, M., Cardinale, F., Cravidi, C., Duse, M., Martelli, A., Minasi, D., del Giudice, M. M., Pajno, G., Peroni, D. G., Tosca, M. A., Licari, A., & Ciprandi, G. (2021). Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology. Allergologia Et Immunopathologia, 49(2), 133-154. https://doi.org/10.15586/aei.v49i2.44
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How to Cite
Marseglia, G. L., Manti, S., Chiappini, E., Brambilla, I., Caffarelli, C., Calvani, M., Cardinale, F., Cravidi, C., Duse, M., Martelli, A., Minasi, D., del Giudice, M. M., Pajno, G., Peroni, D. G., Tosca, M. A., Licari, A., & Ciprandi, G. (2021). Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology. Allergologia Et Immunopathologia, 49(2), 133-154. https://doi.org/10.15586/aei.v49i2.44