Chang Anne B, Oppenheimer John J, Weinberger Miles M, Rubin Bruce K, Weir Kelly, Grant Cameron C, Irwin Richard S
Menzies School of Health Research, Respiratory Department, Lady Cilento Children's Hospital, and Queensland University of Technology, QLD, Australia.
New Jersey Medical School and Pulmonary and Allergy Associates, Morristown, NJ.
Chest. 2017 Apr;151(4):875-883. doi: 10.1016/j.chest.2016.12.025. Epub 2017 Jan 16.
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.
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.
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.
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-β agonist) 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).
使用管理算法或路径可能会改善临床结局。我们进行了系统评价，以基于关键问题（KQs），采用人群、干预措施、对照、结局格式，研究儿童（年龄≤14岁）慢性咳嗽通用管理方法（使用咳嗽算法和检查）的各个方面。
我们使用胸部专家咳嗽小组的系统评价方案、美国胸科医师学会（CHEST）的方法学指南以及推荐分级评估、制定和评价框架。系统评价的数据结合患者的价值观和偏好以及临床背景用于形成推荐意见。采用德尔菲法获得最终分级。
综合针对五个关键问题的系统评价数据，我们发现高质量证据表明，慢性咳嗽的系统管理方法可改善临床结局。虽然有来自多种路径的证据，但最高质量的证据来自使用CHEST方法。然而，对于所提出的一些关键问题，没有或几乎没有证据。
与2006年咳嗽指南相比，现在有高质量证据表明，对于年龄≤14岁的慢性咳嗽（持续时间>4周）儿童，使用咳嗽管理方案（或算法）可改善临床结局，咳嗽管理或检查算法应根据咳嗽的相关特征和临床病史而有所不同。应进行胸部X光检查，并在适当年龄进行肺功能测定（使用β受体激动剂前后）。其他检查不应常规进行，应根据临床情况以及儿童的临床症状和体征进行（例如，儿童接触过结核时进行结核检查）。
