Chronic cough and gastroesophageal reflux in children: Chest guideline and expert panel report

CHEST Expert Cough Panel

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P ¼.78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalAnnals of the Rheumatic Diseases
Volume78
Issue number3
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Gastroesophageal Reflux
Cough
Thorax
Guidelines
Randomized Controlled Trials
Placebos
Therapeutics
Proton Pump Inhibitors
Pulmonary diseases
Pediatrics
Lung Diseases
Meta-Analysis

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Chronic cough and gastroesophageal reflux in children : Chest guideline and expert panel report. / CHEST Expert Cough Panel.

In: Annals of the Rheumatic Diseases, Vol. 78, No. 3, 01.01.2019, p. 131-140.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95{\%} CI, 0.45-2.93; P ¼.78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.",
author = "{CHEST Expert Cough Panel} and Chang, {Anne B.} and Oppenheimer, {John J.} and Kahrilas, {Peter J.} and Ahmad Kantar and Rubin, {Bruce K.} and Miles Weinberger and Irwin, {Richard S.} and Adams, {Todd M.} and Altman, {Kenneth W.} and Elie Azoulay and Barker, {Alan F.} and Bolser, {Donald C.} and Birring, {Surinder S.} and Braman, {Sidney S.} and Christopher Brightling and Priscilla Callahan-Lyon and Terrie Cowley and Paul Davenport and {El Solh}, {Ali A.} and Patricio Escalante and Field, {Stephen K.} and Dina Fisher and French, {Cynthia T.} and Cameron Grant and Peter Gibson and Harding, {Susan M.} and Philip Gold and Anthony Harnden and Hill, {Adam T.} and Joanne Kavanagh and Kefang Lai and Kaiser Lim and {Mark Madison}, J. and Malesker, {Mark A.} and Stuart Mazzone and Lorcan McGarvey and Metlay, {Joshua P.} and Alex Molasoitis and {Hassan Murad}, M. and Mangala Narasimhan and Peter Newcombe and John Oppenheimer and Mark Rosen and Bruce Rubin and Russell, {Richard J.} and Ryu, {Jay H.} and Sonal Singh and Jaclyn Smith and Smith, {Maeve P.} and Tarlo, {Susan M.}",
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T1 - Chronic cough and gastroesophageal reflux in children

T2 - Chest guideline and expert panel report

AU - CHEST Expert Cough Panel

AU - Chang, Anne B.

AU - Oppenheimer, John J.

AU - Kahrilas, Peter J.

AU - Kantar, Ahmad

AU - Rubin, Bruce K.

AU - Weinberger, Miles

AU - Irwin, Richard S.

AU - Adams, Todd M.

AU - Altman, Kenneth W.

AU - Azoulay, Elie

AU - Barker, Alan F.

AU - Bolser, Donald C.

AU - Birring, Surinder S.

AU - Braman, Sidney S.

AU - Brightling, Christopher

AU - Callahan-Lyon, Priscilla

AU - Cowley, Terrie

AU - Davenport, Paul

AU - El Solh, Ali A.

AU - Escalante, Patricio

AU - Field, Stephen K.

AU - Fisher, Dina

AU - French, Cynthia T.

AU - Grant, Cameron

AU - Gibson, Peter

AU - Harding, Susan M.

AU - Gold, Philip

AU - Harnden, Anthony

AU - Hill, Adam T.

AU - Kavanagh, Joanne

AU - Lai, Kefang

AU - Lim, Kaiser

AU - Mark Madison, J.

AU - Malesker, Mark A.

AU - Mazzone, Stuart

AU - McGarvey, Lorcan

AU - Metlay, Joshua P.

AU - Molasoitis, Alex

AU - Hassan Murad, M.

AU - Narasimhan, Mangala

AU - Newcombe, Peter

AU - Oppenheimer, John

AU - Rosen, Mark

AU - Rubin, Bruce

AU - Russell, Richard J.

AU - Ryu, Jay H.

AU - Singh, Sonal

AU - Smith, Jaclyn

AU - Smith, Maeve P.

AU - Tarlo, Susan M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P ¼.78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.

AB - BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P ¼.78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.

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