Recommendations for the assessment and management of cough in children

Shields, Michael; Bush, Andrew; Everard, Mark L.; McKenzie, S A; Primhak, R A

doi:10.1136/thx.2007.077370

Cited by 206 publications

(318 citation statements)

References 121 publications

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“…Guidelines on the diagnosis and management of chronic cough in childhood are available elsewhere [21]. Since wheeze is the end result of narrowing of intrathoracic airways and expiratory flow limitation, irrespective of the underlying mechanism, there are numerous reasons for a child to wheeze, including anatomical abnormalities of the airways, cystic fibrosis and bronchomalacia.…”

Section: Definitionsmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Definitionsmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

750

759

View full text Add to dashboard Cite

show abstract

“…A review conducted by Chung et al reported that the presence of environmental pollutants is one of the most common causes for cough in children particularly in school going children [20]. The British Thoracic Society (BTS) recommends the use of antihistamines in children with productive cough and in allergic cough that has occurred in the pollen season [21]. While cetirizine is essential to combat allergic cough, inclusion of ambroxol to the treatment regimen is essential as it promotes cough clearance of mucous and facilitates reduction of surface adhesion between mucous and airway epithelium [9].…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Benefit of Addition of Cetirizine to Ambroxol in Fixed Dose Combination in the Treatment of Productive Cough in Children: A Prospective, Multi-center Study

Garg¹

2017

AJIM

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Abstract:Productive cough is a common problem in children and is accompanied by disruption of sleep and routine daily activities leading to a deterioration in quality of life. We evaluated the efficacy, safety and tolerability of cetirizine and ambroxol fixed dose combination (FDC) as compared with ambroxol in these patients. We conducted open-label, prospective, multicenter study attending outpatient department with cough ≥12 hours; were screened to receive either cetirizine and ambroxol FDC (AC group) or ambroxol alone (AX group). Primary efficacy variables were evaluation of total symptom score (TSS) for cough and secondary efficacy variables included evaluation of total nasal symptom score (TNSS); assessment of cough frequency; number of awakenings due to cough; and time to complete relief. Out of 250 children included, 246 completed the study with a statistically significant improvement in TSS from baseline to day 3 (p=0.029) and day 7 (p=0.048) in the AC group as compared with AX group. Improvement in TNSS was better in the AC group from baseline to day 3 (p<0.0001) and day 7 (p=0.016) as compared with the AX group. Greater proportion of children in the AC group recovered completely from cough by day 7 (97.67%) as compared with the AX group (78.63%). As side effects, only two children of the AC group experienced mild AEs (drowsiness). We thus conclude that FDC demonstrated improved efficacy and safety and was well tolerated as compared with ambroxol alone in children with productive cough.

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“…Pri večini otrok s kašljem lahko z natančno anamnezo in telesnim pregledom ugotovimo, ali so ti specifični kazalci prisotni ali ne in se glede na to odločimo, ali so potrebne nadaljnje preiskave (3)(4)(5).…”

Section: Uvodunclassified

“…Pri tej skupini otrok dodatnih preiskav praviloma ni potrebno opraviti. Potrebno je le skrbno spremljanje, dokler kašelj ne izzveni (3,4). Nasprotno pa je kronični produktivni kašelj vedno posledica kronične pljučne bolezni, zaradi česar je potrebna nadaljnja diagnostična obravnava.…”

Section: Uvodunclassified

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Praprotnik

Županić²,

Lozej³

et al. 2017

SlovMedJour

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in delovna skupina za pediatrično pulmologijo IzvlečekKašelj je zelo pogosta težava pri otroku. Glede na trajanje ga delimo na akutni kašelj (do tri tedne), subakutni (3-8 tednov) in kronični (več kot 8 tednov).Akutni kašelj je najpogosteje posledica virusnih okužb dihal, ki izzvenijo same po sebi. Potrebno pa je izključiti morebitne resne osnovne bolezni.Subakutni kašelj se najbolj pogosto pojavi po akutni okužbi dihal (postinfekcijski kašelj) in izzveni brez specifičnega zdravljenja. Če je otrok sicer zdrav, kašelj pa suh, se postopno izboljšuje in niso prisotni specifični kazalci, ki bi kazali na resno bolezen, je potrebno otroka le spremljati. Če pa obstaja možnost, da je subakutni kašelj posledica aspiracije tujka, kronične pljučne bolezni ali če se kašelj stopnjuje, je potrebno čimprej opraviti dodatne preiskave.Tudi kronični kašelj je najpogosteje posledica okužb dihal, lahko pa tudi težkih bolezni, ki ogrožajo življenje. Potrebno je ločiti med specifičnim kašljem (poleg kašlja so prisotni simptomi in znaki osnovne bolezni) in nespecifičnim kašljem (prisoten je le suh kašelj brez drugih simptomov in znakov bolezni).Da bi preprečili nepotrebne preiskave in neučinkovito zdravljenje otrok s kašljem, ob tem pa ne bi spregledali katere od težkih bolezni, je potrebno upoštevati priporočila za obravnavo otrok s kašljem, ki temeljijo na medicini, podprti z dokazi. AbstractCough is a common problem in children. Acute cough lasts less than 3 weeks, subacute 3-8 weeks and chronic cough more than 8 weeks.Acute cough is usually caused by common viral upper respiratory tract infection. However, the child should be thoroughly evaluated to rule out a serious underlying condition or disease responsible for the cough.The commonest cause of subacute cough is a viral infection (postinfectious cough) and it usually resolves spontaneously. If the child is otherwise well and the cough is dry and there are no specific alerts for a serious disease and the cough is resolving, a period of observation is all that is recommended. If there are any specific pointers in history and examination identified for an inhaled foreign body, chronic lung disease, or in a case of progressive cough, immediate investigations are needed.Most chronic coughs in childhood are due to viral infections, but may signify a serious underlying disease too. Chronic cough is subdivided into specific cough (i.e., cough associated with other symptoms and signs suggestive of an associated or underlying problem) and nonspecific cough (i.e., dry cough in the absence of an identifiable respiratory disease of known etiology).

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Recommendations for the assessment and management of cough in children

Cited by 206 publications

References 121 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Therapeutic Benefit of Addition of Cetirizine to Ambroxol in Fixed Dose Combination in the Treatment of Productive Cough in Children: A Prospective, Multi-center Study

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