Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology

• Gian Luigi Marseglia ^[1] ; Sara Manti ^[2] ; Elena Chiappini ^[3] ; Ilaria Brambilla ^[1] ; Carlo Caffarelli ^[4] ; Mauro Calvani ^[8] ; Fabio Cardinale ^[9] ; Claudio Cravidi ^[10] ; Marzia Duse ^[5] ; Alberto Martelli ^[11] ; Domenico Minasi ^[12] ; Michele Miraglia del Giudice ^[13] ; Giovanni Pajno ^[6] ; Diego G. Peroni ^[7] ; Maria Angela Tosca ^[14] ; Amelia Licari ^[1] ; Giorgio Ciprandi ^[15]
  1. [1] University of Pavia

     University of Pavia

     Pavía, Italia

     
  2. [2] University of Catania

     University of Catania

     Catania, Italia

     
  3. [3] University of Florence

     University of Florence

     Firenze, Italia

     
  4. [4] University of Parma

     University of Parma

     Parma, Italia

     
  5. [5] Università de Roma La Sapienza

     Università de Roma La Sapienza

     Roma Capitale, Italia

     
  6. [6] University of Messina

     University of Messina

     Mesina, Italia

     
  7. [7] University of Pisa

     University of Pisa

     Pisa, Italia

     
  8. [8] Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy.
  9. [9] Pediatric Unit, Azienda Ospedaliero-Universitaria “Policlinico-Giovanni XXIII”, Bari, Italy.
  10. [10] ASST-Pavia, Pavia, Italy.
  11. [11] Pediatric Unit, ASST-Rhodense, Garbagnate Milanese (MI), Italy.
  12. [12] Pediatric Unit, Grande Ospedale Metropolitano, Reggio Calabria, Italy.
  13. [13] Department of Woman and Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy.
  14. [14] Allergy Center, Istituto Giannina Gaslini, Genoa, Italy.
  15. [15] Allergy Clinic, Casa di Cura Villa Montallegro, Genoa, Italy.

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• Localización: Allergologia et immunopathologia: International journal for clinical and investigate allergology and clinical immunology, ISSN-e 1578-1267, ISSN 0301-0546, Vol. 49, Nº. 2, 2021, págs. 133-154
• Idioma: inglés
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• Resumen

  • The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.

    Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to inter-professional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach.

    Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family.

    Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice.