Background: Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes

Chang, AB

Glasgow, NJ

Landau, LI

Masters, IB

Mellis, CM

Morris, PS

Robertson, CF

Teoh, L

van Asperen, PP

English

PubMed

BACKGROUND: Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. METHODS/DESIGN: We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250) fulfilling inclusion criteria (new patients with chronic cough) are randomised (allocation concealed) to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks) or usual care (existing care until review by specialist at 6 weeks). Cough diary, cough-specific quality of life (QOL) and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses). A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. DISCUSSION: The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years). This study will provide additional evidence on the optimal management of chronic cough in children. TRIAL REGISTRATION: ACTRN12607000526471

University of Melbourne Institutional Repository

Trials

Can a management pathway for chronic cough in children improve clinical outcomes: Protocol for a multicentre evaluation

AB Chang

CF Robertson

PP van Asperen

NJ Glasgow

IB Masters

CM Mellis

LI Landau

L Teoh

PS Morris

Crossref

Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation

Springer - Publisher Connector

Abstract Background Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. Methods/Design We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250) fulfilling inclusion criteria (new patients with chronic cough) are randomised (allocation concealed) to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks) or usual care (existing care until review by specialist at 6 weeks). Cough diary, cough-specific quality of life (QOL) and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses). A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. Discussion The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years). This study will provide additional evidence on the optimal management of chronic cough in children. Trial registration ACTRN12607000526471</p

Masters IB

Glasgow NJ

van Asperen PP

Robertson CF

Chang AB

Mellis CM

Landau LI

Teoh L

Morris PS

Directory of Open Access Journals

BACKGROUND Chronic cough is common and is associated with significant economic and human costs. While cough can be a problematic symptom without serious consequences, it could also reflect a serious underlying illness. Evidence shows that the management of chronic cough in children needs to be improved. Our study tests the hypothesis that the management of chronic cough in children with an evidence-based management pathway is feasible and reliable, and improves clinical outcomes. METHODS/DESIGN We are conducting a multicentre randomised controlled trial based in respiratory clinics in 5 major Australian cities. Children (n = 250) fulfilling inclusion criteria (new patients with chronic cough) are randomised (allocation concealed) to the standardised clinical management pathway (specialist starts clinical pathway within 2 weeks) or usual care (existing care until review by specialist at 6 weeks). Cough diary, cough-specific quality of life (QOL) and generic QOL are collected at baseline and at 6, 10, 14, 26, and 52 weeks. Children are followed-up for 6 months after diagnosis and cough resolution (with at least monthly contact from study nurses). A random sample from each site will be independently examined to determine adherence to the pathway. Primary outcomes are group differences in QOL and proportion of children that are cough free at week 6. DISCUSSION The clinical management pathway is based on data from Cochrane Reviews combined with collective clinical experience (250 doctor years). This study will provide additional evidence on the optimal management of chronic cough in children. TRIAL REGISTRATION ACTRN12607000526471

Chang, A. B

Robertson, C. F.

Glasgow, Nicholas

Masters, I. B.

Mellis, C. M.

Landau, L. I.

Teoh, Laurel

Morris, P. S.

Van Asperen, Peter P.

The Australian National University

Chang, A. B.

van Asperen, P. P.

Glasgow, N. J.

Teoh, L.

University of Queensland eSpace

A: General Practice Activity

AB: Evaluation and outcome of young children with chronic cough. Chest

Acworth JP: Randomized controlled trial of 5 vs 3 days of oral corticosteroids for non-hospitalized asthma exacerbations in children.

CF: Randomised controlled trial of inhaled salbutamol and beclomethasone for recurrent cough. Arch Dis Child

CF: Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method. Eur Respir J

Chang AB: Development of a parent-proxy quality-of-life chronic cough-specific questionnaire: clinical impact vs psychometric evaluations. Chest

Chang AB: Persistent cough in children - overuse of medications.

Chang AB: Utility of clinical pathways for chronic cough in children. Cochrane Database of Systematic Review. Cochrane Database Syst Rev

Chang AB: Utility of signs and symptoms of chronic cough in predicting specific cause in children. Thorax

Chang AB: Validation of a parent-proxy quality-of-life questionnaire (PC-QOL) for paediatric chronic cough. Thorax

Chang AB: What is the burden of chronic cough for families? Chest

CM: The Thoracic Society of Australia and New Zealand. Position statement. Cough in children: definitions and clinical evaluation.

Dagli E: Foreign body aspiration: what is the outcome? Pediatr Pulmonol

Diagnosing chronic cough in children. Thorax

Diagnosis and Management of Cough: ACCP Evidence-Based Clinical Practice Guidelines. Chest

EW: Protocol-driven care in the intensive care unit: A tool for quality. Critical Care

Glomb WB: Guidelines for evaluating chronic cough in pediatrics: ACCP Evidence-Based Clinical Practice Guidelines. Chest

Holgate ST: Descriptive study of cough, wheeze and school absence in childhood. Thorax

How important is quality of life in pediatric asthma? Pediatr Pulmonol Suppl

ID: Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax

Measuring quality of life in the parents of children with asthma. Qual Life Res

ML: Outcomes in Children Treated for Persistent Bacterial Bronchitis. Thorax

New respect for old conditions. Pediatr Pulmonol

PD: Lung function values from a longitudinal study of healthy children and adolescents. Pediatr Pulmonol

PS: PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care

Realities of practice. Engaging parents and GPs in developing clinical practice guidelines. Aust Fam Physician

Statement: updated guidelines for reporting parallel group randomised trials. Trials

Stiell IG: Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA

Tarlo SM: Diagnosis and Management of Cough Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines. Chest

The use of protocols for nutritional support is definitely needed in the intensive care unit. Crit Care Med

Torzillo PJ: Non-CF bronchiectasis-clinical and HRCT evaluation. Pediatr Pulmonol

Very high dose inhaled corticosteroids: panacea or poison? Arch Dis Child

Woolcock AJ: Persistent cough: is it asthma? Arch Dis Child

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2989328

Can a management pathway for chronic cough in children improve clinical outcomes: protocol for a multicentre evaluation

Abstract

Similar works

Full text

Available Versions

University of Melbourne Institutional Repository

Crossref

Springer - Publisher Connector

Springer - Publisher Connector

Directory of Open Access Journals

The Australian National University

University of Queensland eSpace