Cough Remedies for Children and Adolescents: Current and Future Perspectives
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THERAPY IN PRACTICE
Cough Remedies for Children and Adolescents: Current and Future Perspectives Sara Manti1 · Maria Angela Tosca2 · Amelia Licari3 · Ilaria Brambilla3 · Thomas Foiadelli3 · Giorgio Ciprandi4 · Gian Luigi Marseglia3
© Springer Nature Switzerland AG 2020
Abstract Cough is a widespread symptom in children and adolescents. Despite advances in scientific knowledge about the neurophysiological mechanisms underlying the cough reflex, the best therapeutic approaches for children and adolescents who cough remain unclear, and many needs are still unmet. Many remedies for cough are self-prescribed, reflecting strong demand, but significant evidence of their efficacy and safety is missing in pediatric populations. Moreover, as most coughs are part of self-limited illnesses, treatment could be considered unnecessary in some patients. Drug therapy to relieve cough and other symptoms is an essential part of treating a child with cough. However, unfortunately, the number of studies in each category of cough medications is minimal, and dosing and treatment duration varies significantly among studies. Some treatments have been shown to be no more effective than placebo. Lack of clear indications for dosing and treatment duration, the number of available drugs, the numerous active ingredients in products, and multiple caregivers administering medication to children have been considered contributors to an increased risk of inappropriate prescribing, accidental overdosing, and adverse events. This review presents the most recent evidence on the safety and efficacy of available cough remedies, focusing on the pediatric age group, and includes H1 receptor antagonists, mucolytics and expectorants, drugs acting peripherally on the cough reflex, drugs acting centrally on the cough reflex, drugs acting both peripherally and centrally on the cough reflex, and other compounds, including menthol, glycerol, honey, and medical devices composed of complex natural substances. Future perspectives on new therapeutic targets are also discussed.
1 Introduction Pharmacological management is an essential part of the care of children and adolescents with cough. Despite advances in scientific knowledge about the neurophysiological mechanisms underlying the cough reflex, the best therapeutic approaches for children and adolescents who cough remain unclear, and many needs are still unmet. * Giorgio Ciprandi [email protected] 1
Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
2
Allergy Center, Istituto Giannina Gaslini, Genoa, Italy
3
Pediatric Clinic, Pediatrics Department, Policlinico San Matteo, University of Pavia, Pavia, Italy
4
Allergy Clinic, Casa di Cura Villa Montallegro, Via P. Boselli 5, 16146 Genoa, Italy
Key Points Drug therapy is commonly used to relieve acute cough and other associated symptoms in children and adolescents. The best therapeutic approaches for children and adolescents with acute cough remain unclear, and many needs are sti
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