Inhaled corticosteroids for subacute cough in children

Abstract

BackgroundCough is the most common symptom presenting to primary healthcare services. Cough in children is associated with significant morbidity for both children and their parents. While inhaled corticosteroids (ICS) can potentially reduce cough associated with airway inflammation and airway hyper-reactivity, use of ICS in children is not without potential adverse effects. Therefore, it would be beneficial to clinical practice to evaluate the evidence for the efficacy of ICS in reducing the severity of cough in children with subacute cough (defined as cough duration of two to four weeks) systematically. ObjectivesTo evaluate the efficacy of ICS in reducing the severity of cough in children with subacute cough. Search methodsThe Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The latest searches were performed in November 2011. Selection criteriaAll randomised controlled trials (RCTs) comparing ICS with a control group in children with subacute cough were considered for inclusion. Data collection and analysisSearch results were reviewed against pre-determined criteria for inclusion. Two sets of review authors independently selected, extracted and assessed the data for inclusion. Study authors were contacted for further information where required. Data were analysed as 'intention to treat'. Main resultsThe search identified 1178 potentially relevant titles; however, there were no published studies that were specifically designed to answer this question. Two studies met criteria for inclusion in the review and 98 children were included in the meta-analysis. There was no significant difference between groups in the proportion of children 'not cured' at follow-up (primary outcome measure), with a pooled odds ratio (OR) of 0.61 (95% confidence interval (CI) 0.24 to 1.55). However, the included studies were limited in their ability to * The basis f or the assumed risk (e.g. the m edian control group risk across studies) is provided in f ootnotes. The corresponding risk (and its 95% conf idence interval) is based on the assum ed risk in the com parison group and the relative effect of the intervention (and its 95% CI). CI: conf idence interval; OR: odds ratio. GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our conf idence in the estim ate of ef f ect. M oderate quality: Further research is likely to have an im portant im pact on our conf idence in the estim ate of ef f ect and m ay change the estim ate. Low quality: Further research is very likely to have an im portant im pact on our conf idence in the estim ate of ef f ect and is likely to change the estim ate. Very low quality: We are very uncertain about the estim ate.1 Allocation concealm ent and blinding was unclear in both included studies. Random isation sequence generation was not described. 2 In both included studies there was a lim itation in the directness of the answers t...

Efficacy of Grintuss® pediatric syrup in treating cough in children: a randomized, multicenter, double blind, placebo-controlled clinical trial

“…In recent researches, many of the most common medications used to treat cough are nowadays studied to evaluate not only their efficacy, but also safety, in order to underline how benefits/risks ratio tent toward their beneficial effects [ 6 - 8 ]. In most cases, the pharmacological treatment aims to suppress the symptom (cough suppressant therapy), with synthetic agents that play an inhibitory effect on the cough reflex or act as mucolytic drugs, with the simple intent to reduce both intensity and frequency of cough in the short term, increasing the possibility to experience side effects [ 9 - 12 ].…”

Analysis of the Literature on Chronic Cough in Children

“…There are two SRs regarding the use of inhaled corticosteroids [39, 40]. Among the various selected works, only one trial (which contained serious methodological defects) demonstrated a relatively modest efficacy of fluticasone dipropionate for nocturnal cough [41].…”

“…In regard to these latter Cochrane SR references [ 29 - 33 ], our research failed to discover any subsequent noteworthy trials. There are two SRs regarding the use of inhaled corticosteroids [ 39 , 40 ]. Among the various selected works, only one trial (which contained serious methodological defects) demonstrated a relatively modest efficacy of fluticasone dipropionate for nocturnal cough [ 41 ].…”

Role of antitussive agents in the treatment of acute respiratory viral infections and influenza

“…Ряд исследований и метаанализов, выполненных в последнее время, продемонстрировали отсутствие убедительной эффективности по снижению частоты и выраженности кашля у широкого круга препаратов, традиционно используемых как у детей, так и взрослых [9,[25][26][27][28]. Большая часть работ, подтверждаю щих эффективность той или иной медикаментозной терапии при остром кашле, выполнена несколько десятилетий назад и является низкого качества.…”