The Cochrane Library and the Treatment of Chronic Cough in Children: An Overview of Reviews

Abstract

AbstractBackgroundChronic cough is a universal condition of childhood that affects approximately one in ten children. Chronic cough can be either specific (‘wet’ cough or other symptoms concurrently present) or nonspecific (‘dry’ cough in the absence of other symptoms). Compared to adults, specific and non‐specific chronic cough in children differs in terms of both aetiology and treatment, and the methods used to treat chronic cough in adults may actually be harmful for children.ObjectiveThis overview of reviews synthesizes the evidence currently in the Cochrane Library Database of Systematic Reviews (CDSR) in order to answer the following question: in the treatment of childhood specific and non‐specific chronic cough, which pharmacologic or non‐pharmacologic treatments improve cough symptoms and decrease adverse events?MethodsThe Cochrane Database of Systematic Reviews was searched using the terms ‘specific cough’, ‘non‐specific cough’, ‘moist cough’ and ‘chronic cough’ in the record title for all systematic reviews examining pharmacologic or non‐pharmacologic interventions for the treatment of chronic cough in children. Data were extracted, complied into tables, and synthesized using qualitative and quantitative methods.Main ResultsSix reviews (five on non‐specific cough and one on specific cough) were indentified for inclusion. For non‐specific cough, one review found that very high‐dose inhaled corticosteroids were effective in reducing non‐specific cough (RR: 2.04; 95% CI: 1.10, 3.77), but this treatment was not advocated. To date, there is no evidence that anti‐histamines, β2 agonists, gastro‐oesophageal reflux treatments or leukotriene receptor antagonists are efficacious for the treatment of non‐specific chronic cough. For specific cough related to isolated wet cough, there was significant clinical improvement when children were treated with antibiotics (RR: 2.42; 95% CI: 1.65, 3.53). Limited data were available for adverse events associated with any of the treatment options.Authors' ConclusionsThe paucity of RCT evidence in the management of children with chronic cough is striking. Five systematic reviews on interventions for non‐specific cough do not support an empirical treatment approach. One systematic review on interventions for specific cough found some support for the use of antibiotics. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration