2023+澳大利亚立场声明:儿童和成人咳嗽的诊断、评估和管理(英文更新版).pdf
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1、 MJA 20231Position statement summaryCough in Children and Adults:Diagnosis,Assessment and Management(CICADA).Summary of an updated position statement on chronic cough in AustraliaJulie M Marchant1,2,Anne B Chang1,2,3,Emma Kennedy4,David King5,Jennifer L Perret6,Andre Schultz7,8,Maree R Toombs9,Lesle
2、y Versteegh3,Shyamali C Dharmage6,Rebecca Dingle10,Naomi Fitzerlakey10,Johnson George11,Anne Holland12,13,14,Debbie Rigby5,15,Jennifer Mann14,16,Stuart Mazzone17,Mearon OBrien10,Kerry-Ann OGrady1,Helen L Petsky18,Jonathan Pham19,Sheree MS Smith20,Danielle F Wurze21,Anne E Vertigan22,23,Peter Wark22,
3、23Cough is a common condition leading to clinical consultation and results in significant health care costs.Guidelines seek to standardise and assist in diagnosis,investigation and management of cough.1,2 Cough in Children and Adults:Diagnosis,Assessment and Management(CICADA)is an updated Australia
4、n position statement on the clinical assessment and management of chronic cough that highlights the burden of chronic cough,including the disproportionate burden in our First Nations population.We provide recommendations for initial assessment of chronic cough in clinical practice,including red flag
5、s in history and examination,and CICADA diagnostic management algorithms for use in paediatrics(Box1)and adults(Box2).As there is high quality evidence that the common aetiologies of chronic cough in children and adults are not the same,we discuss the management of paediatric and adult chronic cough
6、 separately.3MethodCICADA was developed by a multidisciplinary expert committee that convened to undertake a systematic literature review and discuss updated recommendations.A total of 6395 articles were screened and 277 new studies since 2010(the previous CICADA update)4 were included in the update
7、d full statement(Box3 provides details of the guideline development process).Throughout the position statement(in the main text and in the box summarising the recommendations and their level of evidence and strength),the GRADE of evidence6 refers to evidence of the efficacy of treatment recommendati
8、ons for cough in association with the respective conditions.The full statement can be found at https:/lungf ounda .au/resou rces/cicada-full-posit ion-state ment.We plan to update the statement every 2 years.Burden of chronic coughIn 2015,the prevalence of chronic cough in adults was estimated to be
9、 9.6%(95%CI,7.6 11.7%)globally,7 and 8.8%in Australia.8 The prevalence of chronic cough gradually increases to peak in the sixth decade9 and has been estimated to occur in 3%of never smokers,4%of former smokers and 8%of current smokers.10 Overall,chronic cough presents more commonly in middle-aged w
10、omen.2There are limited Australian studies on population prevalence of chronic cough in children.11 In a recent study of Australian children presenting to emergency departments,7.5%had chronic cough,and 20 23%had persistent cough at day 28 irrespective of duration of cough on presentation.12 The pre
11、valence of chronic wet cough in children living in Indigenous communities is higher(around 13%).131 Australian Centre for Health Services Innovation,Queensland University of Technology,Brisbane,QLD.2 Queensland Childrens Hospital,Brisbane,QLD.3 Menzies School of Health Research,Darwin,NT.4 Rural and
12、 Remote Health,Flinders University,Darwin,NT.5 University of Queensland,Brisbane,QLD.6 Melbourne School of Population and Global Health,University of Melbourne,Melbourne,VIC.7 Wal-yan Respiratory Research Centre,Perth,WA.8 Perth Childrens Hospital,Perth,WA.9 University of Sydney,Sydney,NSW.10 Lung F
13、oundation Australia,Brisbane,QLD.11 Centre for Medicine Use and Safety,Monash University,Melbourne,VIC.12 Alfred Health,Melbourne,VIC.13 Monash University,Melbourne,VIC.14 Institute for Breathing and Sleep,University of Melbourne,Melbourne,VIC.15 Queensland University of Technology,Brisbane,QLD.16 A
14、ustin Health,Melbourne,VIC.17 University of Melbourne,Melbourne,VIC.18 Griffith University,Brisbane,QLD.19 Alfred Health,Melbourne,VIC.20 Western Sydney University,Sydney,NSW.21 Royal Childrens Hospital,Melbourne,VIC.22 Hunter Medical Research Institute,University of Newcastle,Newcastle,NSW.23 John
15、Hunter Hospital,Newcastle,NSW.jm.marchantqut.edu.au doi:10.5694/mja2.52157AbstractIntroduction:Cough is the most common symptom leading to medical consultation.Chronic cough results in significant health care costs,impairs quality of life,and may indicate the presence of a serious underlying conditi
16、on.Here,we present a summary of an updated position statement on cough management in the clinical consultation.Main recommendations:Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease.Further as
17、sessment with examination should include a chest x-ray and spirometry(when age6years).Separate paediatric and adult diagnostic management algorithms should be followed.Management of the underlying condition(s)should follow specific disease guidelines,as well as address adverse environmental exposure
18、s and patient/carer concerns.First Nations adults and children should be considered a high risk group.The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https:/lungf ounda .au/resou rces/cicada-full-posit
19、 ion-state ment.Changes in management as a result of this statement:Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended.High quality evidence supports the use of child-specific chronic cough management algorithms to improve clinical outcomes,but none exist i
20、n adults.Red flags that indicate serious underlying conditions requiring investigation or referral should be identified.Early and effective treatment of chronic wet/productive cough in children is critical.Culturally specific strategies for facilitating the management of chronic cough in First Natio
21、ns populations should be adopted.If the chronic cough does not resolve or is unexplained,the patient should be referred to a respiratory specialist or cough clinic.MJA 20232Position statement summary1 Algorithm for diagnosis and assessment of a child with chronic cough PBB=protracted bacterial bronc
22、hitis 2 Algorithm for diagnosis and assessment of an adult with chronic coughACE=angiotensin-converting enzyme;COPD=chronic obstructive pulmonary disease;CT=computed tomography;ENT=ear,nose and throat;ICS=inhaled corticosteroids;FeNO=fractional exhaled nitric oxide;GORD=gastro-oesophageal reflux dis
23、ease;ppb=parts per billion;RAST=radioallergosorbent test;SPT=skin prick test.13265377,0,Downloaded from https:/ by CochraneChina,Wiley Online Library on 20/11/2023.See the Terms and Conditions(https:/ Wiley Online Library for rules of use;OA articles are governed by the applicable Creative Commons L
24、icense MJA 20233Position statement summaryFirst Nations Australians are disproportionately affected by conditions that present with chronic wet cough,such as protracted bacterial bronchitis and bronchiectasis.The mortality difference between First Nations and non-First Nations Australians with bronc
25、hiectasis is about 22 years.14 In 180 First Nations children aged 4 weeks in children,3 and 8 weeks in adults(Box5).22 The initial assessment for chronic cough relies on history and examination to identify any red flags indicators that may signal an underlying disease or systemic exposure(Box 6).Pro
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