An expert consensus on managing cough in Indian pediatric practice: airway disease education and expertise 2.0 (2024)
DOI:
https://doi.org/10.18203/2319-2003.ijbcp20243049Keywords:
Pediatric cough, ADEX 2.0, Expert consensus recommendationsAbstract
Cough in children is one of the most frequent presenting symptoms in health care settings. Coughing can significantly affect a child's sleep and level of activity, which often causes parents’ distress. Promptly addressing chronic cough may enhance the quality of life in children and reduce the considerable stress on parents. In 2017, airway disease education and expertise (ADEX) NEXT recommendations for diagnosis, management, and follow-up of persistent (chronic) cough were published. For the present work 27 modified Delphi consensus statements were prepared, and a survey was undertaken involving 30 expert pediatricians from across India. The opinions of the expert panel on the updates related to pediatric chronic cough awareness, diagnosis, and management were collected. Consensus was predetermined to be obtained if more than 75% of the participants agreed or remained neutral for the statement. All the statements were supported by the latest data from the literature search. All the statements reached consensus after an agreement of more than 75%. Consequently, all the opinions from experts were consolidated and expert recommendations were framed. Children presenting with cough should be treated in accordance with child-specific guidelines. The present expert recommendations can be utilized by pediatricians to make well-informed decisions when treating pediatric patients with cough. The management of cough in children should be determined by the underlying cause, where a prompt and efficient therapy can result in early resolution.
References
Swain SK, Munjal S, Pradhan S. Pediatric cough. Apollo Med. 2019;16(2):87-92.
Weinberger M, Hurvitz M. Diagnosis and management of chronic cough: similarities and differences between children and adults. F1000Research. 2020;9.
Jurca M, Ramette A, Dogaru CM, Goutaki M, Spycher BD, Latzin P, et al. Prevalence of cough throughout childhood: a cohort study. PLoS One. 2017;12(5):e0177485.
Cheng ZR, Chua YX, How CH, Tan YH. Approach to chronic cough in children. Singapore Med J. 2021;62(10):513.
Bavdekar SB, Vora A, Karekar S. Pediatric cough as a symptom: Tips for management. Indian J Child Health. 2022;9(9):158-63.
Paramesh H, Nimain M, Vijay K, Vikram P, Rohit R, Gaurav P, et al. Cough profile and trends in cough management in children across India: Results of a multi-centric, cross-sectional survey. J Pediatr Assoc India. 2019;8(1):18.
Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1):260-83.
Paramesh H, Mohanty NC, Kumar R, Kumar P, Sivabalan S, Vaidya PC, et al. Airway Disease Education & Expertise (ADEX) NEXT Working Group Recommendations-Persistent (Chronic) Cough in Pediatric Practice. J Pediatr Assoc India. 2017;6(4):230-43.
Thomas M, Bomar PA. Upper Respiratory Tract Infection. In: StatPearls. StatPearls Publishing, Treasure Island (FL). 2023.
Chan GC, Tang SF. Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore Med J. 2006;47(4):266-70.
Lamas A, Ruiz de Valbuena M, Máiz L. Cough in children. Arch Bronconeumol. 2014;50(7):294-300.
Scott K. Chronic cough in children. InnovAiT. 2021;14(6):356-63.
Mahashur A. Chronic dry cough: Diagnostic and management approaches. Lung India. 2015;32(1):44-9.
De Blasio F, Virchow JC, Polverino M, Zanasi A, Behrakis PK, Kilinç G, et al. Cough management: a practical approach. Cough. 2011;7:1-2.
Shaheed CA, Maher CG, McLachlan A. Investigating the efficacy and safety of over-the-counter codeine containing combination analgesics for pain and codeine based antitussives. Woden: Government of Australia, Department of Health, Therapeutic Goods Administration. 2016. Available at: https://www.tga.gov.au/sites/default/files/review-efficacy-and-safety-over-counter-codeine-combination-medicines.pdf. Accessed on 17 October 2023.
Nagaraju K, Shah R, Ganapathy S, Roy S, Bhatia R, Kumar PS, et al. Practical Approach for the Diagnosis, Prevention, and Management of Recurrent Upper Respiratory Tract Infection in Children: Report from an Expert Closed-group Discussion. Pediatr Infect Dis. 2021;3(3):106.
Skoner DP, Greos LS, Kim KT, Roach JM, Parsey M, Baumgartner RA. Evaluation of the Safety and Efficacy of Levalbuterol in 2–5‐year‐Old Patients with Asthma. Pediatr Pulmonol. 2005;40(6):477-86.
Michaelson ED, Silva GT, Forrest TR, Marks MB, Serafini SM, Sackner MA. Effects of oral terbutaline in children with bronchial asthma. J Allerg Clini Immunol. 1978;61(6):365-9.
Manaligod LM, Gavani UD, Hyde JS, Khurana S. Safety and effectiveness of terbutaline in children with chronic asthma. Chest. 1979;76(5):532-5.
Schifano F, Chiappini S, Miuli A, Mosca A, Santovito MC, Corkery JM, et al. Focus on over-the-counter drugs' misuse: a systematic review on antihistamines, cough medicines, and decongestants. Front Psychiatr. 2021;12:657397.
Lee JH, Lee JW, An J, Won HK, Park SY, Lee JH, et al. Efficacy of non-sedating H1-receptor antihistamines in adults and adolescents with chronic cough: A systematic review. World Allerg Org J. 2021;14(8):100568.
Marchant JM, Petsky HL, Morris PS, Chang AB. Antibiotics for prolonged wet cough in children. Cochrane Database Syst Rev. 2018(7).
Hox V, Lourijsen E, Jordens A, Aasbjerg K, Agache I, Alobid I, et al. Benefits and harm of systemic steroids for short-and long-term use in rhinitis and rhinosinusitis: an EAACI position paper. Clin Transl Allerg. 2020;10:1-27.
Diab N, Patel M, O’Byrne P, Satia I. Narrative review of the mechanisms and treatment of cough in asthma, cough variant asthma, and non-asthmatic eosinophilic bronchitis. Lung. 2022;200(6):707-16.
Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidisciplin Resp Med. 2017;12:1-1.
Zanasi A, Mazzolini M, Kantar A. A reappraisal of the mucoactive activity and clinical efficacy of bromhexine. Multidisciplin Resp Med. 2017;12:1-4.
Kiran MD, Pawaskar LJ, Sheikh SN, Kiran M. Efficacy and Safety for the Combination of Levosalbutamol, Ambroxol and Guaifenesin for the Symptomatic Treatment of Productive Cough: Phase IV Clinical Trial. Int J Inno Res Med Sci. 2019;4(01):1.
Rumore MM. Clinical pharmacokinetics of chlorpheniramine. Drug Intell Clin Pharm. 1984;18(9):701-7.
Fang D, Bao Y. Clinical study on the efficacy and safety of Dextromethorphan Hydrochloride, Chlorphenamine Malente, and Ammonium Chloride Syrup on eliminating or relieving the symptoms of acute upper respiratory infection in children. J Clin Pediatr. 2016:910-6.
Xu W, Xia S, Pu J, Wang Q, Li P, Lu L, et al. The antihistamine drugs carbinoxamine maleate and chlorpheniramine maleate exhibit potent antiviral activity against a broad spectrum of influenza viruses. Front Microbiol. 2018;9:2643.
Westover JB, Ferrer G, Vazquez H, Bethencourt-Mirabal A, Go CC. In vitro virucidal effect of intranasally delivered chlorpheniramine maleate compound against severe acute respiratory syndrome coronavirus 2. Cureus. 2020;12(9):1.
Polverino E, Goeminne PC, McDonnell MJ, Aliberti S, Marshall SE, Loebinger MR, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Resp J. 2017;50(3):1.
Lv HJ, Qiu ZM. Refractory chronic cough due to gastroesophageal reflux: definition, mechanism and management. World J Methodol. 2015;5(3):149.
Lee SC, Yang YH, Chuang SY, Huang SY, Pan WH. Reduced medication use and improved pulmonary function with supplements containing vegetable and fruit concentrate, fish oil and probiotics in asthmatic school children: a randomised controlled trial. Br J Nutr. 2013;110(1):145-55.