Chest
Original Research: Signs and Symptoms of Chest DiseaseChildren With Chronic Wet or Productive Cough—Treatment and Investigations: A Systematic Review
Section snippets
Materials and Methods
The systematic reviews were conducted based on the protocol11 established by selected members of the CHEST expert cough panel. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for reporting.
The searches for both questions were conducted by librarians from the University of Massachusetts Medical School between July 19, 2015, and July 27, 2015, using the search strategies outlined in e-Table 1 and e-Table 2. For the CHEST cough guidelines, it was
Results
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagrams for both KQs are presented in Figures 1 and 2, respectively. The risk of bias assessment for the three RCTs12, 13, 14 related to KQ1 was combined in a single figure (Fig 3).
Discussion
We performed two related systematic reviews involving the management of chronic (> 4 weeks) wet/productive cough in children. We found high-quality evidence that in children (aged ≤ 14 years) with chronic wet cough unrelated to an underlying lung disease, antibiotics directed against common bacteria pathogens (H influenzae [nontypeable when typing was performed], M catarrhalis, and S pneumoniae) improved cough resolution. In general, a 2-week course is sufficient but up to 4 weeks may be
Conclusion
Our systematic review relating to key questions on the management of chronic wet cough in children has found high-quality evidence that the use of appropriate antibiotics improves cough resolution, and when specific cough pointers (eg, digital clubbing) are present in children with wet cough, further investigations (eg, flexible bronchoscopy, chest CTs, and immunity tests) should be undertaken. There is moderate-quality evidence that children should be referred to a major center for
Acknowledgments
Author contributions: A. B. C., J. J. O., and R. S. I. drafted the key questions and all authors reviewed them; A. B. C. and J. J. O. selected the studies, extracted data, and undertook the bias assessment. A. B. C. drafted the manuscript, had full access to the data, and takes responsibility for the integrity of all of the data and the accuracy of the data analysis. All authors critically reviewed the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the
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