Etiologies of chronic cough in pediatric cohorts – CHEST Guideline and Expert Panel Report

Background

In children (aged ≤14-years) there is no published systematic review on the etiologies of chronic cough or, the relationship between obstructive sleep apnea (OSA) and chronic cough. We thus undertook systematic reviews based on key questions (KQs) using the PICO format. The KQs were: Among children with chronic (>4 weeks) cough: (1) are the common etiologies different from adults? (2) are the common etiologies age and/or setting dependent? and; (3) is obstructive sleep apnea (OSA) an etiology of chronic cough in children?

Methods

We used the CHEST expert cough panel's protocol and the American College of Chest Physicians (CHEST) methodological guidelines and GRADE 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 consensus.

Results

Combining KQs 1 and 2, we found moderate level evidence from 10 prospective studies that the etiologies of cough in children are different from adults, and are setting dependent. Data from 3 studies found that common etiologies of cough in young children were different from older children. However, data relating sleep abnormalities to chronic cough in children were only found in case studies.

Conclusion

There is moderate quality evidence that common etiologies of chronic cough in children are different from that in adults and are dependent on age and setting. As there are few data relating OSA with chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.

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