*For medical professionals only
What are the key takeaways?
Organisation: Yuan Xueqing
Cough is a common symptom and cause of respiratory diseases in children, and the cognition of the diagnosis and treatment of cough in children in mainland primary medical institutions is generally not the same, and it has certain particularities. Therefore, it is very important to provide standardized and scientific diagnosis and treatment guidance for grassroots medical workers and improve their management of children's cough.
Recently, the "Clinical Practice Guidelines for the Diagnosis and Treatment of Cough in Children in China (2023 Grassroots Edition)" (hereinafter referred to as the "2023 Guidelines") was released. In this issue of the "Author's Talk" column, the "Medical Pediatric Channel" is fortunate to invite two authors of the guideline, Professor Liu Enmei from the Children's Hospital of Chongqing Medical University and Professor Lu Quan from the Children's Hospital of Shanghai Jiao Tong University, to explain the 2023 version of the guideline in detail and reveal the story behind the formulation of the guideline.
Diagnosis and treatment technology and resource allocation are limited, and targeted guidelines are urgently needed for the diagnosis and treatment of cough in children at the grassroots level
Professor Lu Quan said that since the release of the Guidelines for the Diagnosis and Treatment of Chronic Cough in Children (Trial) in 2008, it has been nearly 20 years, during which he has maintained long-term cooperation with Professor Liu Enmei, and in 2013, another version of the Guidelines for the Diagnosis and Treatment of Chronic Cough in Children was launched. Subsequently, the Clinical Practice Guidelines for the Diagnosis and Treatment of Cough in Children in China (2021 Edition) (hereinafter referred to as the "2021 Professional Guidelines") and the Guidelines for Cough in Children in China (2021 Patient Edition) were launched one after another.
However, due to the vast territory of the mainland, the distribution of medical technology and resources is uneven, and the understanding of the diagnosis and treatment of children's cough by grassroots doctors is not exactly the same as that of higher-level hospitals. In order to solve this practical contradiction and further improve the management level of children's cough in primary medical institutions, the Clinical Pharmacology Group of the Pediatric Branch of the Chinese Medical Association has jointly formulated the 2023 version of the guidelines. The guideline formulation working group is composed of experts in pediatrics, evidence-based medicine, pharmacy, nursing and other disciplines, and consists of 4 teams, which fully consulted the opinions of 339 grassroots doctors in 17 provincial-level administrative regions through preliminary research, and formed 17 evidence-based recommendations and recommendations for 9 important issues of urgent concern in children's cough assessment, diagnosis, medication, referral and health education.
Professor Liu Enmei introduced that compared with the 2021 professional version of the guidelines, the 2023 version of the guidelines introduces the characteristics, indications and adverse reactions of drugs from the perspective of pharmacy, and adds new conditions for specific available drugs (such as antihistamines, antibacterial drugs, cough and expectorant drugs), thus adding practicality. In addition, the 2023 version of the guidelines also adds the identification of acute and critical diseases, respiratory signs that may be caused by cough, and refines the indications for referral and health education at the grassroots level, which is more suitable for guiding the clinical practice of grassroots doctors. Professor Lu Quan added that the evidence grading of the 2023 version of the guidelines introduces the concept of "Good Practice Statement (GPS)", which adopts and recommends a statement based on expert consensus for important clinical issues for which there is no direct evidence, and guides grassroots doctors to refer to it in practice.
Scientific, applicable, and guided by the actual needs of the grassroots level, the content of the guide is formulated
Professor Lu Quan emphasized that the 2023 version of the guide is not a comprehensive update of the 2021 professional version of the guide, but a new attempt and supplement on its basis. Because primary hospitals may not have the facilities and experience to perform certain examinations, the 2023 version of the guidelines does not repeat the description of auxiliary diagnosis (see the 2021 professional version of the guidelines for diagnosis for details), and the first five questions are mainly related to the treatment of cough in children, in addition, detailed suggestions are given for the identification of critical illness, recognition of signs other than the respiratory system, indications for referral, and family communication.
Here, Prof. Liu Enmei and Prof. Lu Quan mainly sorted out the following four major issues:
Table 1: The four major clinical problems and management strategies of the guideline
It is important to note that acute cough and PIC in children are self-limited and usually resolve spontaneously, and antimicrobial drugs cannot reduce cough or shorten the duration of the disease, but may lead to adverse drug reactions and induce bacterial resistance, so they are not routinely recommended.
Empowered by scientific research and practice, we have formulated guidelines for the diagnosis and treatment of children's cough with Chinese characteristics
Professor Lu Quan and Professor Liu Enmei said that among the 17 recommendations in the 2023 version of the guideline, 47.1% are strong recommendations (6 are recommended at 1A+1B level and 2 are recommended at 2B level), nearly 1/3 are medium-weak recommendations (5 are at 2C+2D level), and nearly 1/4 are GPS (4 are recommended, accounting for 23.5%), which shows that the quality of the guidelines is dynamically improving. In addition, the 2023 version of the guidelines has added medication recommendations, identification and referral of acute and critical diseases, health education, etc., which increases the practicability of the guidelines and brings them closer to primary medical institutions, which is quite valuable for reference for grassroots doctors.
Talking about the limitations of the 2023 version of the guidelines, the two professors said that most of the primary doctors in the 2023 version of the guidelines expert group are from secondary medical institutions, and the proportion of primary and lower medical institutions should be increased. This guideline only selects the most important and controversial 9 prominent issues in primary clinical practice to form 17 recommendations and recommendations, and does not generalize (for example, the treatment of specific cough caused by pertussis, influenza, new crown, etc. is not covered). The 2023 version of the guidelines also does not elaborate on the causes of cough in children, auxiliary examinations and other issues, and grassroots doctors can combine the 2023 version of the guidelines and the 2021 professional version of the guidelines to carry out clinical practice more comprehensively.
Talking about the future direction of efforts, Professor Lu Quan pointed out that the current search found that the number of high-quality clinical studies and systematic reviews on children's cough in China is still small, which will affect the collection and update of evidence-based evidence, and more high-quality, multi-center, and large-sample studies need to be carried out. In addition, efforts should be made to promote and jointly apply the 2023 and 2021 professional guidelines at all levels, construct the transformation of guideline evidence, reduce the differences in cough diagnosis and treatment between different levels of medical institutions and different medical personnel, pursue homogeneity, and improve the level of diagnosis and treatment and service quality.
Finally, the two professors pointed out that cough and chronic cough are only a symptom, and the etiology of cough/chronic cough should be clarified as much as possible in clinical work, and keep in mind that neither cough nor chronic cough is the end point of diagnosis, but the starting point of etiological diagnosis and differential diagnosis. It is expected that after continuous exploration and practice, grassroots doctors can formulate a more local, individualized diagnosis and treatment plan for children on the basis of the 2023 version of the guidelines. The expert group for formulating guidelines can also insist on starting from the actual situation in China, learn from international excellent experience, and formulate more wonderful and authoritative guidelines for the diagnosis and treatment of cough in children that are in line with China's national conditions.
For more comparisons between the 2023 version of the guideline recommendations and the 2021 version of the guideline, click at the end of the article to read the original article to view~
Expert Profile
Professor Liu Enmei
- Doctor of Medicine/Doctor of Philosophy, second-level professor, doctoral supervisor
- Vice President of the Children's Hospital of Chongqing Medical University
- Chief Scientist of the National Key R&D Program
- Young and middle-aged experts with outstanding contributions to national health
- Expert who enjoys the special government allowance of the State Council
- Outstanding talents of the new century of the Ministry of Education
- Leading expert of Chongqing Chief Expert Studio
- Leader of Chongqing Talent Innovation and Entrepreneurship Team
- Group Leader, Clinical Pharmacology Group, Pediatric Branch, Chinese Medical Association
- Deputy head of the National Childhood Asthma Collaborative Group
- Vice Chairman of the Pediatric Branch of Chongqing Medical Association
- He has successively won the second prize of the Ministry of Education's Science and Technology Progress Award, the first prize, the second prize and the third prize of Chongqing Science and Technology Progress Award, the 7th Chongqing Youth Science and Technology Award, the third prize of the Chinese Medical Association, and the first prize of the Science and Technology Progress Award of the Chinese Women's and Children's Association
Expert Profile
Professor Lu Quan
- Chief physician, member of the Antimicrobial Drug Professional Group of the Expert Committee on Rational Drug Use of the National Health Commission, and consultant of the Children's Drug Professional Group.
- He used to be the vice president of Shanghai Children's Hospital and a member of the Academic Committee of Shanghai Jiao Tong University School of Medicine. He is currently an advisor to the Children's Drug Committee of the Pediatric Branch of the Chinese Medical Association and a consultant to the Clinical Pharmacology Group.
- He is an advisor to the Society of Infection and Chemotherapy of the Shanghai Medical Association, and a consultant of the 3rd Clinical Application and Management Committee of Antimicrobial Drugs of the Shanghai Municipal Health Commission. Leader of the respiratory professional group of Shanghai Pediatric Clinical Quality Control Center.
- He is a member of the Academic Steering Committee of the Chinese Journal of Pediatrics, an associate editor-in-chief of the Chinese Journal of Practical Pediatrics, an associate editor-in-chief of the Chinese Journal of Infection and Chemotherapy, and an executive deputy editor-in-chief of the Chinese Journal of Evidence-Based Pediatrics. He has won the third prize of the National Science and Technology Progress Award, the third prize of the Chinese Medical Science and Technology Award, and the second prize of the Science and Technology Progress Award of the Ministry of Education.
- In 2018, he won the "Outstanding Contribution Award for Rational Drug Use for Children" by the National Health and Family Planning Commission, and the "6th Chinese Pediatrician Lifetime Achievement Award" by the Chinese Medical Association
Click to read the original article and download the Doctor Station App to view~
References:[1] Clinical Pharmacology Group of the Pediatric Branch of the Chinese Medical Association, National Clinical Research Center for Child Health and Diseases, Respiratory Group of the Pediatric Branch of the Chinese Medical Association, et al. Clinical Practice Guidelines for the Diagnosis and Treatment of Cough in Children in China (2023 Grassroots Edition)[J]. Chin J Pediatric,2024,62(4):292-302. DOI:10.3760/cma.j.cn112140-20240112-00046.
This article is reviewed: Prof. Liu Enmei, Children's Hospital Affiliated to Chongqing Medical University, and Prof. Lu Quan, Editor-in-Charge of Children's Hospital, Shanghai Jiao Tong University: Xiang Yu
*The Medical Community strives to be professional and reliable in its published content, but does not make any commitment to the accuracy of the content.
to learn more clinical skills