xRead - Globus and Chronic Cough (April 2024)

TABLE3 ] Summary of Therapies Used for Non-speci fi c Cough as Reported in Literature Based on Controlled Trials

Time to Response a

Therapy

Level of Evidence

Data Limitation and Considerations

Anti-histamines

Adverse events (especially with H1 antagonist) Non-bene fi cial from 3 RCTs in children fi cial in systematic review. 194 Single small study showed bene fi t by 2wk of treating allergic cough in children with pollen allergy with cetirizine 195 Non-bene

Acute cough

1wk

Systematic review (with OTC medications 193 )

Systematic review 194

Chronic cough

2wk

Some may require 4 wks 73

Anti-microbials (for chronic wet/productive cough)

2wk

Systematic reviews and meta analysis 73

Asthma type therapy Cromones

Systematic review 196

Single open trial only 197

2wk

Systematic review, 198 single case series 199 RCTs, 45,46 systematic review 141

Anti-cholinergics

4wk

No trials in children. Case series unclear

Inhaled corticosteroids

2-4wks

Small bene

fi t if any, adverse event

No RCTs, adverse events 200

Oral corticosteroids

Not relevant No RCTs

Adverse events 47

Beta-2-agonist

Not relevant Systematic review 201

Acute cough

Non-bene

fi cial

Systematic review, 140 RCT 46 Observational studies 202-204 Systematic review 205

Chronic cough

Non-bene

fi cial

Theophylline

1-2wk

No RCTs, adverse events

Systematic review 142

Leukotriene receptor antagonist

No trials in children

GERD therapy

Not relevant Single controlled trial 206

Motility agents

No bene

fi t, adverse events,

systematic review on metoclopramide 207 showed no bene fi t for GER but cough was not an outcome measure

Not relevant Systematic reviews 5-7

Acid suppression

Adverse events

Systematic review, 5 RCTs 208,209

Food thickening or anti-re fl ux formula

1wk

Inconclusive data; one reported increase in cough 208 and a second reduction 209 fi t, systematic showed no bene fi t for GER and cough was not an outcome measure 210 No bene

Not relevant Systematic review 207

Head positioning

Fundoplication

No data

No RCT, adverse events

Herbal anti-tussive therapy

No data

No RCTs

Nasal therapy

RCT 156

Nasal steroids

1-2wk

Mainly adults and older children ( > 12 y) in RCT, bene fi cial when combined with antibiotics for sinusitis 211,212

Other nasal sprays

No data

No RCT, adverse events Adverse events 214,215

Over the counter

Not relevant Systematic review 11,193

Acute cough

Honey maybe bene fi cial, other OTC medications were non-bene fi cial

Systematic review for codeine 213

Chronic cough

No studies

Physical therapies steam, vapor, rubs

No data

No RCTs, adverse events eg, burns

No data ¼ no pediatric data. GER ¼ GI gastroesophageal re fl ux; OTC ¼ over-the-counter; RCT ¼ randomized controlled trial. a Time to response

¼ expected reduction in cough severity if treatment is effective, as reported by trialists.

321

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