Anti-histamines for prolonged non-specific cough in children

 

Abstract

Background

Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including anti-histamines. Also, anti-histamines are advocated as an empirical treatment in adults with chronic cough.

Objectives

To evaluate the effectiveness of anti-histamines in treating children with prolonged non-specific cough.

Search methods

We searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, OLDMEDLINE and EMBASE databases. The latest searches were performed in November 2009.

Selection criteria

All randomised controlled trials comparing anti-histamines with a placebo or placebo-like medication with cough as an outcome, where cough is not primarily related to an underlying respiratory disorder such as cystic fibrosis, asthma, or suppurative lung disease.

Data collection and analysis

Two review authors independently assessed study quality and extracted data.

Main results

Three included therapeutic studies had 182 randomised participants with 162 completing the trials although in one study, children with recurrent wheeze were also included. The four included safety evaluation studies randomised 3166 participants with 2862 completing the trials. Clinical heterogeneity was evident and limited data prevented combining data for meta-analysis. The two larger therapeutic studies described significant improvement in both the intervention and the placebo/placebo-like arms with no significant difference between the two groups. In the study with the smallest sample size, cetirizine (a second generation anti-histamine) was significantly more efficacious than placebo in reducing chronic cough in children associated with seasonal allergic rhinitis, and the effect was seen within two weeks of therapy. In contrast three of the larger evaluation studies that enrolled children with allergic rhinitis described a non-significant increase in cough as an adverse event. Combined data from the four safety evaluation studies revealed a non-significant difference between groups (OR 1.47 , 95% CI 0.86, 2.49) for cough as an adverse event but the trend favoured the placebo arm.

Authors' conclusions

This review has significant limitations. However, our finding of uncertain efficacy of anti-histamines for chronic cough are similar to that for acute cough in children. In contrast to recommendations in adults with chronic cough, anti-histamines cannot be recommended as empirical therapy for children with chronic cough. If anti-histamines were to be trialled in these children, current data suggest a clinical response (time to response) occurs within two weeks of therapy. However the use of anti-histamines in children with non-specific cough has to be balanced against the well known risk of adverse events especially in very young children.

 

Plain language summary

Anti-histamines for prolonged non-specific cough in children

Children with non-specific cough are commonly treated with a variety of medications to treat the symptom of cough. The objective of this review was to evaluate the effectiveness of anti-histamines in children with prolonged cough that is not related to an underlying respiratory disease, that is, non-specific chronic cough. We included three therapeutic studies with 182 randomised participants. Two studies found that chronic cough significantly improved in both treatment and placebo groups with no difference between the two groups. One small study however described that children who had chronic cough associated with seasonal allergic rhinitis treated with cetirizine improved significantly more than children on placebo and this difference was evident by two weeks. Four studies that evaluated safety profiles included 3166 randomised participants and described a non significant increase in cough in participants who received the active medication. Despite the limitations of this review, our findings are similar to the review on anti-histamines for acute cough which showed no good evidence for or against the use of anti-histamines. In contrast to recommendations in adults with chronic cough, anti-histamines cannot be recommended as empirical therapy for children with chronic cough. Further research examining the effects of this treatment using child appropriate cough outcome measures is needed.

 

摘要

背景

用抗組織胺治療兒童長期非特異性咳嗽

非特異性咳嗽定義為無找到特定呼吸疾病或原因的無痰性咳嗽，其在兒童醫療中很常見。這類兒童被用各種方式治療，包括抗組織胺。而且抗組織胺也被提倡用在成人慢性咳嗽的經驗治療

目標

評估用抗組織胺治療兒童長期非特異性咳嗽之效果

搜尋策略

由Cochrane Airways Group蒐尋The Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, OLDMEDLINE及EMBASE。最後搜尋日期為2006年11月

選擇標準

比較抗組織胺與安慰劑或類安慰劑藥物，並以咳嗽作為結果的所有隨機對照試驗，其咳嗽與潛在的呼吸疾病不相關，例如囊性纖維化(cystic fibrosis)、氣喘、或膿性肺病

資料收集與分析

依據已設定的收集標準來回顧所搜尋的結果。兩位評論者各自挑選、抽取、及評估入選資料。找到3個符合的試驗

主要結論

這3個研究在病患年紀、病患數目、收集標準、抗組織胺種類、及治療時間都各不相同，共包括了182位隨機分配的病患，其中162位完成試驗，但有一個研究把復發哮喘的兒童也包括在內。由於有明顯的臨床差異性且資料有限，無法把資料合併做統合分析。兩個較大的研究顯示不論在處置組或安慰劑/類安慰劑組都有明顯進步，而且兩組間沒有明顯差異。而其中最小型的研究顯示，在減少有季節性過敏性鼻炎兒童的慢性咳嗽方面，cetirizine(第二代抗組織胺)明顯比安慰劑有效，且其效果在治療兩週內可顯現

作者結論

這篇回顧有明顯的限制，然而我們找到的證據顯示用抗組織胺治療兒童慢性咳嗽的效果不確定，就如同其對急性咳嗽的效果也不確定。相對於建議抗組織胺用在成人慢性咳嗽，我們無法建議將其用在兒童慢性咳嗽的經驗治療。如果想在這類兒童試用抗組織胺，目前資料顯示臨床反應(治療反應出現時間)會在治療兩週內顯現。但用抗組織胺治療兒童非特異性咳嗽須衡量其常見的不良作用風險，尤其在年紀非常小的兒童

翻譯人

本摘要由國泰綜合醫院楊璧如翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

非特異性咳嗽的兒童常被用各種藥物來治療其咳嗽症狀。此篇回顧的目的在評估抗組織胺對於兒童無潛在呼吸疾病的長期咳嗽，即非特異性慢性咳嗽，之效果。兩個研究顯示不論在治療組或安慰劑組，慢性咳嗽都明顯改善，且兩組之間無差異。一個小型研究針對兒童有季節性過敏性鼻炎相關的慢性咳嗽，用cetirizine比安慰劑可明顯改善症狀，且這個差別在兩週內顯現。儘管這個回顧的資料有限，但我們找到的證據類似關於抗組織胺治療急性咳嗽的結論，皆沒有好的證據可證明用抗組織胺之好壞。相對於建議抗組織胺用在成人慢性咳嗽，我們無法建議用在兒童慢性咳嗽的經驗治療。需要更多用適當兒童咳嗽結果評量標準的研究來探討這種治療的效果