Inhaled anti-cholinergics for prolonged non-specific cough in children

Antitussive Drugs—Past, Present, and Future

“…Studies evaluating the clinical effect of muscarinic receptor antagonists in pathologic cough in adults are sparse and nonexistent in children (Chang et al, 2004). In one controlled, double-blind crossover trial evaluating 14 adult nonsmokers with persistent, postviral cough, inhaled ipratropium bromide significantly improved subjectively rated cough compared with placebo (Holmes et al, 1992), whereas oxitropium bromide did not demonstrate antitussive activity, based on subjective assessment, in a randomized, double-blind placebocontrolled study of 56 nonasthmatic volunteers with URTI (Lowry et al, 1994).…”

Recommendations for the assessment and management of cough in children

“…Most of the features of a cough and investigations have not been formally evaluated for their predictive value in the diagnosis of a specific condition. In the Cochrane Library database, three recent systematic reviews of treatment of prolonged non-specific cough in children (inhaled anticholinergics, theophyllines and cromones) found no eligible randomised controlled trials (RCTs) and, in a further review (treatment of gastro-oesophageal reflux), three paediatric studies were found but none could be included in the meta-analysis 14 – 17…”

Defining the Cough Spectrum and Reviewing the Evidence for Treating Non-Specific Cough in Children

“…There is only one study on use of inhaled salbutamol in prolonged cough (median of 8 weeks) which also showed no benefit [72]. In a Cochrane review no evidence was found to support the use of anti-cholinergics for non-specific cough in children [113].…”

“…Anti-microbials 1-2 weeks Systematic reviews [109], RCTs [107,108] Some benefit, adverse events, cost benefit ratio [106] Asthma type therapy Cromones 2 weeks Systematic review [66] Single open trial only [130] Anti-cholinergics No data Systematic review [113] No trials in children Not relevant Systematic review [112], RCT [72] Non beneficial [72,73], adverse events [73] Theophylline 1-2 weeks Observational studies [116][117][118] No RCTs, adverse events…”