Clinical Question Are inhaled bet...

Clinical Question

Are inhaled beta agonists effective for the treatment of chronic, nonspecific cough in children?

Evidence-Based Answer

The single clinical trial onward this topic found that inhaled beta agonists do not contract cough frequency or improve symptoms in children with chronic, nonspecific cough

Practice Pointers

Cough lasting more than three weeks in children frequently is caused by asthma, postnasal drip, gastroesophageal ebb disease, or chronic exposure to irritants of the like kind as tobacco smoke or allergens; it also may be attributed to overestimation of symptoms from parents. Rarely, it is caused by means of a serious problem such as cystic fibrosis or tuberculosis. When these causes have been exclud chronic, nonspecific cough sometimes called "cough variant asthma," many times is diagnosed.

The authors of this systematic review identified no other than one study that compared an inhaled beta agonist with placebo in a randomized, double-blind trial. This cogitation compared inhaled albuterol (Proventil) in a dosage of 200 mcg twice daily via meter dose inhaler with placebo in 42 children who had chronic, nonspecific cough (1) At the expiration of the one-week study, the researchers institute no differences between groups regarding cough common occurrence symptom score, airway responsiveness, or sensitivity of cough receptors to capsaicin. The consideration was small, and although it was powered to lay open a 70 percent difference in cough oftenness between groups, it might have missed a small moreover clinically significant benefit with inhaled beta agonists. The authors note that observational studies and examination of the symptoms of children in placebo clusters suggest that cough tends to improve through the whole extent of time.

Another Cochrane review (2) performed in 2005 at the same group of researchers institute a possible benefit from high-dose inhaled corticosteroids in sum of two units studies with a total of 123 children; however, children in the placebo dispose also improved, and the clinical impact was of uncertain significance. An evidence-based guideline from the Finnish Medical Society (3) praises that treatment with inhaled corticosteroids be considered in children with cough-predominant asthma if pulmonary function testing is abnormal. For younger children who cannot cooperate adequately with pulmonary function testing, an empiric trial of inhaled corticosteroids should be considered.

REFERENCES

(1) Chang AB, Phelan PD Carlin JB Sawyer SM Robertson CF A randomised, placebo controll trial of inhaled salbutamol and beclomethasone for returning cough. Arch Dis Child 1998;79:6-11

(2) Tomerak AA, McGlashan JJ Vyas HH McKean MC Inhaled corticosteroids for non-specific chronic cough in children. Cochrane Database Syst Rev 2005;(4): CD004231

(3) Finnish Medical Society Duodecim. protracted cough in children. In: EBM guidelines. Evidence-based medicine [CD-ROM] Helsinki, Finland: Duodecim Medical Publications Ltd; 2004

(4) Tomerak AA, et al. Inhaled beta2-agonists for treating non-specific chronic cough in children. Cochrane Database Syst Rev 2005;(3):CD005373

The series coordinator for AFP is Clarissa Kripke, MD Department of Family and Community Medicine, University of California, san Francisco.

MARK H EBELL, MD MS

COPYRIGHT 2006 American Academy of Family Physicians

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