Pediatric Cough Research Articles

Meta-analysis of the efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma

Meta-analysis of the efficacy and safety of Ding-Chuan Tang in the treatment of pediatric cough variant asthma

Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications.

* Abbreviations: CCM — : cough and cold medication NPDS — : National Poison Data System For more than 10 years, there have been Food and Drug Administration recommendations and manufacturer labeling changes in place advising against the use of cough and cold medications (CCMs) in young children.1,2 In this issue of Pediatrics , Halmo et al3 present concerning findings characterizing fatalities associated with CCMs in recent years. Identifying cases through the Pediatric Cough and Cold Safety Surveillance System and then using an expert panel for review, the authors report 40 CCM-related fatalities in children under 12 years old that occurred from 2008 to 2016. Although overall fatalities associated with CCMs were rare, they found that most fatalities were in children <2 years old and were of nontherapeutic intent, with more than one-half of nontherapeutic intent cases determined to be malicious in nature. Diphenhydramine, a commonly used antihistamine, was found to be the index-ingredient most often involved in CCM-related fatalities. This important fatality review demonstrates that despite safety efforts, young children remain at risk for death from CCMs. The strengths of the study include the use of a cough-and-cold–specific safety surveillance system that includes data from several national sources and data collection that covered several years after advisory and labeling changes. The surveillance system was limited, however, by self-report and potential misclassification of cases as well as inconsistencies in detailed case information. Autopsy reports were also reviewed, but reports were only available in 55% of cases.3 Therefore, the expert panel could not determine the contributory factors that led to the child’s death in almost one-half of fatalities. Thus, these limitations likely … Address correspondence to Michele M. Burns, MD, MPH, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: michele.burns{at}childrens.harvard.edu

Pediatric Fatalities Associated With Over-the-Counter Cough and Cold Medications.

In 2008, over-the-counter cough and cold medications (CCMs) underwent labeling changes in response to safety concerns, including fatalities, reported in children exposed to CCMs. The objective of this study is to describe fatalities associated with exposures to CCMs in children <12 years old that were detected by a safety surveillance system from 2008 to 2016. Fatalities in children <12 years old that occurred between 2008 and 2016 associated with oral exposure to one or more CCMs were identified by the Pediatric Cough and Cold Safety Surveillance System. An expert panel reviewed all cases to determine the causal relationship between the exposure and death, if the intent of exposure was therapeutic, and if the dose was supratherapeutic. Other contributing factors related to the child's death were also identified as part of a root cause analysis. Of the 180 eligible fatalities captured during the study period, 40 were judged by the expert panel to be either related or potentially related to the CCM. Of these, the majority (n = 24; 60.0%) occurred in children <2 years old and involved nontherapeutic intent (n = 22; 55.0%). The most frequently involved index ingredient was diphenhydramine (n = 28; 70.0%). In 6 cases (n = 6; 15.0%), the CCM was administered to murder the child. In another 7 cases (n = 7; 17.5%), death followed the intentional use of the CCM to sedate the child. Pediatric fatalities associated with CCMs occurred primarily in young children after deliberate medication administration with nontherapeutic intent by a caregiver.

Chuna Manual Therapy for Pediatric Cough: A Systematic Review and Meta-analysis

Chuna Manual Therapy for Pediatric Cough: A Systematic Review and Meta-analysis

Approach to patient with cough by American and Chinese respiratory specialist

Cough is a common pediatric condition. Acute cough is often considered to be self-limiting and not requiring clinical management. However, pediatric patients and their parents often seek remedies for an acute cough. Traditional Chinese Medicine (TCM) specialists have been treating pediatric cough for millennia. Here we present a case of pediatric cough and the approaches taken to it by a Western and Chinese respiratory specialist. We conclude that TCM may provide important and useful insights into the treatment of such pediatric respiratory disease.

Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology.

The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a "wait and see" approach, consisting of parental reassurance and close clinical observation, also due to inter-professional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a "wait and see" approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family.

Efficacy and safety of the syrup \u201cKalobaTUSS\xae\u201d as a treatment for cough in children: a randomized, double blind, placebo-controlled clinical trial

BackgroundAcute cough in children often causes discomfort to children and parents, reducing their quality of life. Despite the extensive utilization of over-the-counter remedies for cough, the efficacy of most of these treatments in children has not been confirmed.MethodsWe conducted a randomized, double blind, placebo-controlled clinical trial of 106 children with acute cough to evaluate the efficacy and safety of KalobaTUSS®, a paediatric cough syrup based on acacia honey and on Malva sylvestris extract, Inula helenium extract, Plantago major extract, and Helichrysum stoechas extract by using a validated 6 points Likert scale.ResultsChildren were orally treated with KalobaTUSS® or placebo for 8 days. Children receiving KalobaTUSS® showed an early and significant reduction in night-time and day-time cough scores measured using a specific scale and a shorter duration of cough than children treated with the placebo.ConclusionsKalobaTUSS® is well tolerated and produces positive effects by reducing the severity and shortening the duration of cough in children.Trial registrationClinicaltrials.gov no. NCT04073251. Retrospectively registered.

Relief of acute cough by cough syrup with mucoprotection

Two randomised, blind, controlled, multicentre studies investigated the therapeutic effect of a chemical and mechanical barrier in the upper airways produced by polysaccharide-resin-honey based cough syrup in children with acute cough associated with a common cold. The mucoprotection led to a significant alleviation of the paediatric cough compared with carbocysteine syrup or placebo. The beneficial effect was especially apparent in children with severe cough and/or episodes of nocturnal coughing.

Relief of acute cough by cough syrup with mucoprotection

Two randomised, blind, controlled, multicentre studies investigated the therapeutic effect of a chemical and mechanical barrier in the upper airways produced by polysaccharide-resin-honey based cough syrup in children with acute cough associated with a common cold. The mucoprotection led to a significant alleviation of the paediatric cough compared with carbocysteine syrup or placebo. The beneficial effect was especially apparent in children with severe cough and/or episodes of nocturnal coughing.

Development and validation of stability indicating method for determination of sodium citrate in pediatric cough syrup

Sodium Citrate is widely used in analytical and food processes. It is used in various medical applications as anticoagulant in blood transfusion process and bladder washout. It is used in cough preparation as mucolytic. There are many methods for determination of Sodium Citrate in different preparations. Some of which use spectrophotometric methods, others used HPLC methods. The USP method uses titration and determining the end point potentionometrically. Many arguments take place between the Drug Regulatory Affairs and manufacturers regarding the appearance of the colour at the end point. The objective of this study is to develop and validate a simple, easy and precise HPLC stability indicating method for routine work and to be submitted to the Drug Regulatory Affairs. Chromatographic system with detector PDA at 210nm is utilized, Reprosil-XR C18, 250 mm×4 mm, 5 µm column is used. Column temperature 300C and flow rate of 1 ml/min. A clear peak of acceptable purity at 3.38 min retention time appears. The method is subjected to thermal stress, acid and base hydrolysis at extreme pH and forced oxidation. The result is that there is no interference of degradation products with the substance peak. The method is then subjected to validation study according to the ICH guidelines. The method comply the specificity, precision, linearity, accuracy and robustness acceptable criteria. Thus, the method satisfies the stability indicating method and validation requirements that it can be submitted to the Drug Regulatory Affairs and used in QC routine activities and stability studies.

Development and validation of stability indicating method for determination of sodium citrate in pediatric cough syrup

Sodium Citrate is widely used in analytical and food processes. It is used in various medical applications as anticoagulant in blood transfusion process and bladder washout. It is used in cough preparation as mucolytic. There are many methods for determination of Sodium Citrate in different preparations. Some of which use spectrophotometric methods, others used HPLC methods. The USP method uses titration and determining the end point potentionometrically. Many arguments take place between the Drug Regulatory Affairs and manufacturers regarding the appearance of the colour at the end point. The objective of this study is to develop and validate a simple, easy and precise HPLC stability indicating method for routine work and to be submitted to the Drug Regulatory Affairs. Chromatographic system with detector PDA at 210nm is utilized, Reprosil-XR C18, 250 mm×4 mm, 5 µm column is used. Column temperature 300C and flow rate of 1 ml/min. A clear peak of acceptable purity at 3.38 min retention time appears. The method is subjected to thermal stress, acid and base hydrolysis at extreme pH and forced oxidation. The result is that there is no interference of degradation products with the substance peak. The method is then subjected to validation study according to the ICH guidelines. The method comply the specificity, precision, linearity, accuracy and robustness acceptable criteria. Thus, the method satisfies the stability indicating method and validation requirements that it can be submitted to the Drug Regulatory Affairs and used in QC routine activities and stability studies.

Development and validation of stability indicating method for determination of sodium citrate in pediatric cough syrup

Development and validation of stability indicating method for determination of sodium citrate in pediatric cough syrup

Simultaneous determination of nine constituents by validated UFLC-MS/MS in the plasma of cough variant asthma rats and its application to pharmacokinetic study after oral administration of Huanglong cough oral liquid

Huanglong cough oral liquid (HL), an important traditional Chinese medicine prescription for treating pediatric cough variant asthma (CVA) in Nanjing hospital of traditional Chinese medicine for many years. In this study, a selective, accurate and sensitive ultra fast liquid chromatography extreme resolution coupled with mass spectrometer (UFLC-MS/MS) method was established and validated for the simultaneous determination of nine constituents including morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin, caffeic acid in CVA rat plasma sensitized and challenged with ovalbumin and cinnamaldehyde. Plasma samples were prepared by protein precipitation with four-fold amount of methanol. UFLC separation was performed on a Thermo Scientific AcclaimTM RSLC 120 C18 column (2.1 mm × 100 mm, 2.2 μm) with mobile phase containing methanol and 0.1% formic acid-water by gradient elution in 8.1 min at total flow of 0.3 mL/min. The determination of target compounds in plasma was operated by multiple reaction monitoring (MRM) mode with positive and negative electrospray ionization (ESI) source. The correlation coefficients (r) of all compounds were from 0.9930 to 0.9994 in the linear range. Lower limit of quantification (LLOQ, ng/mL) was 0.81, 2.01, 2.11, 1.17, 1.04, 0.89, 0.67, 1.45 and 0.59 for morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin and caffeic acid, respectively. Intra- and inter-day accuracy and precision, extraction recovery, matrix effect, carryover effect, dilution integrity, and stability were within the limits specified. The established method was effectively applied to a pharmacokinetic study of the nine compounds in CVA rat plasma following oral administration HL exact (7.5, 15, 30 g/kg).

Microscopic polyangiitis presenting with persistent cough and hemoptysis in pediatrics: a case report and review of the literature

Microscopic polyangiitis presenting with persistent cough and hemoptysis in pediatrics: a case report and review of the literature

Diagnosis and management of chronic cough: similarities and differences between children and adults.

Cough is a natural process that protects the airway. Cough can occur spontaneously or voluntarily. It is considered chronic when it is present for longer than 4 weeks in children or 8 weeks in adults. In both, chronic cough causes patient distress and increased healthcare utilization. Etiologies of pediatric chronic cough include asthma, protracted bacterial bronchitis, tracheomalacia, habit cough, and various systemic disorders. While some diagnoses are identifiable by careful history alone, others require testing guided by specific pointers. Flexible fiberoptic bronchoscopy has been an important tool to identify etiologies of chronic cough that were not otherwise apparent. In adults, asthma and bronchitis are well-defined etiologies of chronic cough, but much chronic cough in adults is largely a conundrum. Reviews of adult chronic cough report that at least 40% of adults with chronic cough have no medical explanation. Gastroesophageal reflux and upper airway cough syndrome (a.k.a. post-nasal drip) have been common diagnoses of chronic cough, but those diagnoses have no support from controlled clinical trials and have been subjected to multiple published critiques. Cough hypersensitivity is considered to be an explanation for chronic cough in adults who have no other confirmed diagnosis. Gabapentin, a neuromodulator, has been associated with a modest effect in adults, as has speech pathology. While habit cough has not generally been a diagnosis in adults, there is evidence for a behavioral component in adults with chronic cough. Treatment for a specific diagnosis provides a better outcome than trials of cough suppression in the absence of a specific diagnosis. More data are needed for chronic cough in adults to examine the hypothesized cough hypersensitivity and behavioral management. This article reviews etiologies and the treatment of chronic cough in children and the conundrum of diagnosing and treating chronic cough in adults.

Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study.

The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients’ previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies.

Symptom network topological features predict the effectiveness of herbal treatment for pediatric cough.

Pediatric cough is a heterogeneous condition in terms of symptoms and the underlying disease mechanisms. Symptom phenotypes hold complicated interactions between each other to form an intricate network structure. This study aims to investigate whether the network structure of pediatric cough symptoms is associated with the prognosis and outcome of patients. A total of 384 cases were derived from the electronic medical records of a highly experienced traditional Chinese medicine (TCM) physician. The data were divided into two groups according to the therapeutic effect, namely, an invalid group (group A with 40 cases of poor efficacy) and a valid group (group B with 344 cases of good efficacy). Several well-established analysis methods, namely, statistical test, correlation analysis, and complex network analysis, were used to analyze the data. This study reports that symptom networks of patients with pediatric cough are related to the effectiveness of treatment: a dense network of symptoms is associated with great difficulty in treatment. Interventions with the most different symptoms in the symptom network may have improved therapeutic effects.

Pediatric Cough

Pediatric Cough

Gastroesophageal reflux and respiratory diseases: does a real link exist?

Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD. This review was conducted employing 2 databases: PubMed and Science Direct. Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations. The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.

Evaluation of the quality and value of data sources for postmarket surveillance of the safety of cough and cold medications in children

BackgroundThe purpose of this report is to evaluate the quality of data sources used to study cough and cold medication (CCM) safety in children via the Pediatric Cough and Cold Safety Surveillance System.MethodsThe System utilized the National Poison Data System (NPDS), FDA Adverse Event Reporting System (FAERS), English-language medical literature, manufacturer postmarket safety databases, and news/media reports to identify cases from January 2008 through September 2016. Each data source was evaluated by the proportion of detected cases determined to be eligible (met case criteria) and the proportion determined to be evaluable (able to determine causal relationship between adverse event and exposure).ResultsA total of 7184 unique cases were identified from 27,597 detected reports. Of these, 6447 (89.7%) were evaluable. The data source with the highest volume of detected cases was news/media; however, only 0.3% of those cases were eligible for panel review and only 0.2% (24 out of 13,450 cases) were evaluable. The data source with the highest proportion of eligible and evaluable cases was NPDS with 7691 detected cases, 6113 (79.5%) eligible cases, and 5587 (72.6%) evaluable cases.ConclusionsThe data sources utilized to evaluate the safety profile of pediatric CCMs yielded variable detection and evaluation rates, but overall provided a comprehensive look at exposures that otherwise cannot be studied in clinical trials. While this study suggests that each source made a valuable contribution and that evaluable cases are generalizable, improvements are needed in case completeness and accuracy to enhance the quality of postmarket safety evaluations.