Expert opinion and clinical practice recommendations using a modified Delphi approach for pediatric acute cough evaluation and management in India

BACKGROUND AND OBJECTIVE: Cough is the most frequently managed pediatric issue in primary care which needs simplified guidelines and algorithms for general practitioners. METHODS: A modified Delphi method was used to reach the consensus on clinical statements and ways to assess and categorize cough. The panel comprised eight experts, including pediatric pulmonologists, pulmonologists, and pediatricians. RESULTS: Out of total of 49 clinical statements 45 reached consensus in the first round. An expert panel joined in online deliberation to refine the remaining four statements. Experts recommend history taking and clinical examination as the most accurate methods for determining the cause of a child's cough. A dry cough in children typically results from viral infections, allergies, or inhaled irritants, while a wet cough suggests bronchitis, which can be viral, allergic, or bacterial. Sputum colour is not a reliable indicator for differentiating bacterial and viral bronchitis. Multi-ingredient cough and cold medications often contain irrational formulations, increasing the risk of adverse events. Based on initial cough categorization, pediatric cough treatment should target specific symptoms with minimal ingredients. Bronchodilators are used for bronchospasm or wheezing; antihistamines should only be added for allergic symptoms. Cough expectorants help in specific situations with excess mucus. Additional insights include red flag signs, nonpharmacologic therapy, and specialist referral. CONCLUSION: The present consensus fills the existing need and will guide family physicians in successfully diagnosing and managing cough in the primary healthcare setting in India.