The dilemma of persisting productive or wet cough in children without established chronic lung disease: How to treat and when to investigate

Clinicians are frequently confronted by a chronic productive or wet cough in children. A cough of more than 4 weeks is defined as chronic. It is referred to as ‘productive’ when a child is able to expectorate. A similar cough in younger children who are unable to expectorate, will be referred to as a ‘wet’ cough. The most common conditions associated with a chronic productive/wet cough are protracted bacterial bronchitis and bronchiectasis. The early diagnosis, and effective management, of a chronic productive/wet cough is therefore important. It may signal an underlying illness where early and correct management may reduce morbidity and mortality. Chang et al. [1] undertook two related systematic literature reviews aimed at answering two key questions (KQs) on children (≤14 years) who present for the first time with a chronic productive/wet cough in the absence of known chronic lung disease. KQ1: How effective are antibiotics in improving resolution of cough, and if so, which antibiotic(s) and for how long? KQ2: When should they be referred for further investigation? The authors followed the CHEST expert cough panel’s protocol and conducted systemic reviews of randomised controlled trials, and prospective and retrospective cohort crosssectional studies, published in English. Fifteen studies (data on 1 363 children) were included in KQ1 and 17 studies (data on 2 109 children) in KQ2. They concluded that: 1. There is high-quality evidence that the appropriate use of antibiotics improves cough resolution. The number needed to treat for benefit was 3 (95% confidence interval 2.0 - 4.3). 2. There is high-quality evidence that specific cough pointers [2] (e.g.