Chronic cough in children and adolescents: A pragmatic, algorithm-based position paper of the Italian Society of Pediatric Allergy and Immunology.

چکیده اصلی

BACKGROUND: Chronic cough is a common reason for pediatric consultation and may lead to repeated medical visits, caregiver anxiety, inappropriate use of diagnostic tests, and unnecessary treatments. In children and adolescents, chronic cough should be regarded primarily as a symptom of an underlying condition rather than as a standalone diagnosis, requiring age-specific diagnostic pathways. In 2020, the Italian Society of Pediatric Allergy and Immunology (SIAIP) published a document on this issue. OBJECTIVE: To develop a pragmatic, algorithm-based approach for the evaluation and management of chronic cough in children and adolescents, reflecting contemporary evidence and expert consensus; the SIAIP promoted an updated position paper. METHODS: A multidisciplinary panel of experts reviewed the previous document, taking into account international guidelines and key publications on pediatric chronic cough, and integrated the available evidence with clinical expertise. Consensus discussions focused on red flags and specific cough pointers, the classification of cough as wet or dry, treatable traits, and the role of time-limited therapeutic trials with predefined reassessment. RESULTS: The proposed algorithm prioritizes the early identification of red flags that indicate the need for targeted investigations and specialist referral. In children without warning features, cough quality guides subsequent management. Wet cough is addressed primarily through the recognition and appropriate treatment of infective causes, such as protracted bacterial bronchitis. Dry cough is evaluated sequentially for cough-predominant asthma, upper airway cough syndrome, gastroesophageal reflux-related mechanisms, and functional cough. At each step, empirical therapies are limited and require scheduled reassessment, with discontinuation if ineffective. The approach emphasizes the avoidance of prolonged empirical therapy, the rational use of antibiotics, inhaled corticosteroids, alginates, and proton pump inhibitors, and the early reconsideration of the diagnosis when the response is lacking. CONCLUSIONS: This pragmatic algorithm provides a structured, clinically oriented approach to standardize the evaluation and management of chronic cough in children and adolescents. It is intended to support clinical judgment, reduce unwarranted variation in practice, minimize unnecessary investigations and treatments, and promote the timely identification of conditions requiring specialist care. Prospective validation in real-world settings is warranted to assess its impact on outcomes and healthcare utilization.

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