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Depfenhart M, de Villiers D, Lemperle G, Meyer M, Di Somma S. Potential new treatment strategies for COVID-19: is there a role for bromhexine as add-on therapy? Intern Emerg Med 2020; 15:801-812. [PMID: 32458206 PMCID: PMC7249615 DOI: 10.1007/s11739-020-02383-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 05/18/2020] [Indexed: 12/19/2022]
Abstract
Of huge importance now is to provide a fast, cost-effective, safe, and immediately available pharmaceutical solution to curb the rapid global spread of SARS-CoV-2. Recent publications on SARS-CoV-2 have brought attention to the possible benefit of chloroquine in the treatment of patients infected by SARS-CoV-2. Whether chloroquine can treat SARS-CoV-2 alone and also work as a prophylactic is doubtful. An effective prophylactic medication to prevent viral entry has to contain, at least, either a protease inhibitor or a competitive virus ACE2-binding inhibitor. Using bromhexine at a dosage that selectively inhibits TMPRSS2 and, in so doing, inhibits TMPRSS2-specific viral entry is likely to be effective against SARS-CoV-2. We propose the use of bromhexine as a prophylactic and treatment. We encourage the scientific community to assess bromhexine clinically as a prophylactic and curative treatment. If proven to be effective, this would allow a rapid, accessible, and cost-effective application worldwide.
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Affiliation(s)
- Markus Depfenhart
- Faculty of Medicine, Venlo University B.V, Venlo, Netherlands.
- Medical One Clinic Hamburg, Hamburg, Germany.
| | | | | | - Markus Meyer
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, University of Rome Sapienza, Rome, Italy
- GREAT Network Italy, Rome, Italy
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Balbani APS. Cough: neurophysiology, methods of research, pharmacological therapy and phonoaudiology. Int Arch Otorhinolaryngol 2015; 16:259-68. [PMID: 25991944 PMCID: PMC4435438 DOI: 10.7162/s1809-97772012000200016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 06/25/2011] [Indexed: 12/13/2022] Open
Abstract
Introduction: The cough is the more common respiratory symptom in children and adults. Objective: To present a revision on the neurophysiology and the methods for study of the consequence of the cough, as well as the pharmacotherapy and phonoaudiology therapy of the cough, based on the works published between 2005 and 2010 and indexed in the bases Medline, Lilacs and Library Cochrane under them to keywords “cough” or “anti-cough”. Synthesis of the data: The consequence of the cough involves activation of receiving multiples becomes vacant in the aerial ways and of neural projections of the nucleus of the solitary treatment for other structures of the central nervous system. Experimental techniques allow studying the consequence of the cough to the cellular and molecular level to develop new anti-cough agents. It does not have evidences of that anti-cough exempt of medical lapsing they have superior effectiveness to the one of placebo for the relief of the cough. The phonoaudiology therapy can benefit patients with refractory chronic cough to the pharmacological treatment, over all when paradoxical movement of the vocal folds coexists. Final Comments: The boarding to multidiscipline has basic paper in the etiological diagnosis and treatment of the cough. The otolaryngologist must inform the patients on the risks of the anti-cough of free sales in order to prevent adverse poisonings and effect, especially in children.
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Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2014; 2014:CD006088. [PMID: 24615334 PMCID: PMC11023600 DOI: 10.1002/14651858.cd006088.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants). These might provide relief in reducing cough severity, but suppression of the cough mechanism might impede airway clearance and cause harm. OBJECTIVES To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia. SEARCH METHODS We searched CENTRAL 2013, Issue 12, MEDLINE (January 1966 to January week 2, 2014), OLDMEDLINE (1950 to 1965), EMBASE (1980 to January 2014), CINAHL (2009 to January 2014), LILACS (2009 to January 2014) and Web of Science (2009 to January 2014). SELECTION CRITERIA Randomised controlled trials (RCTs) in children and adults comparing any type of OTC cough medication with placebo, or control medication, with cough as an outcome and where the cough is secondary to acute pneumonia. DATA COLLECTION AND ANALYSIS We independently selected trials for inclusion. We extracted data from these studies, assessed them for methodological quality without disagreement and analyzed them using standard methods. MAIN RESULTS There are no new trials to include in this review update. Previously, four studies with a total of 224 participants were included; one was performed exclusively in children and three in adolescents or adults. One using an antitussive had no extractable pneumonia-specific data. Three different mucolytics (bromhexine, ambroxol, neltenexine) were used in the remaining studies, of which only two had extractable data. They demonstrated no significant difference for the primary outcome of 'not cured or not improved' for mucolytics. A secondary outcome of 'not cured' was reduced (odds ratio (OR) for children 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat to benefit (NNTB) at day 10 = 5 (95% CI 3 to 16) and OR 0.32 for adults (95% CI 0.13 to 0.75); NNTB at day 10 = 5 (95% CI 3 to 19)). In a post hoc analysis combining data for children and adults, again there was no difference in the primary outcome of 'not cured or not improved' (OR 0.85, 95% CI 0.40 to 1.80) although mucolytics reduced the secondary outcome 'not cured' (OR 0.34, 95% CI 0.19 to 0.60; NNTB 4, 95% CI 3 to 8). The risk of bias was low or unclear. AUTHORS' CONCLUSIONS There is insufficient evidence to decide whether OTC medications for cough associated with acute pneumonia are beneficial. Mucolytics may be beneficial but there is insufficient evidence to recommend them as an adjunctive treatment for acute pneumonia. This leaves only theoretical recommendations that OTC medications containing codeine and antihistamines should not be used in young children.
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Affiliation(s)
- Christina C Chang
- The Alfred Hospital, Monash UniversityDepartment of Infectious DiseasesCommercial RoadPrahranVictoriaAustralia3181
| | - Allen C Cheng
- 2nd Floor, Burnet Centre, Alfred HospitalDepartment of Epidemiology and Preventive Medicine, Monash UniversityCommercial RoadMelbourneVictoriaAustralia3004
| | - Anne B Chang
- Charles Darwin UniversityMenzies School of Health ResearchPO Box 41096CasuarinaNorthern TerritoriesAustralia0811
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Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2012:CD006088. [PMID: 22336815 DOI: 10.1002/14651858.cd006088.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants). These might provide relief in reducing cough severity, but suppression of the cough mechanism might impede airway clearance and cause harm. OBJECTIVES To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3) which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE (January 1966 to July week 4, 2011), OLDMEDLINE (1950 to 1965), EMBASE (1980 to August 2011), CINAHL (2009 to August 2011), LILACS (2009 to August 2011) and Web of Science (2009 to August 2011). SELECTION CRITERIA Randomised controlled trials (RCTs) in children and adults comparing any type of OTC cough medication with placebo, or control medication, with cough as an outcome and where the cough is secondary to acute pneumonia. DATA COLLECTION AND ANALYSIS We independently selected trials for inclusion. We extracted data from these studies, assessed them for methodological quality without disagreement and analyzed using standard methods. MAIN RESULTS Four studies with a total of 224 participants were included; one was performed exclusively in children and three in adolescents or adults. One using an antitussive had no extractable pneumonia-specific data. Three different mucolytics (bromhexine, ambroxol, neltenexine) were used in the remaining studies, of which only two had extractable data. They demonstrated no significant difference for the primary outcome of 'not cured or not improved' for mucolytics. A secondary outcome of 'not cured' was reduced (odds ratio (OR) for children 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat to benefit (NNTB) at day 10 = 5 (95% CI 3 to 16) and OR 0.32 for adults (95% CI 0.13 to 0.75); NNTB at day 10 = 5 (95% CI 3 to 19). In a post hoc analysis combining data for children and adults, again there was no difference in the primary outcome of 'not cured or not improved' (OR 0.85, 95% CI 0.40 to 1.80) although mucolytics reduced the secondary outcome 'not cured' (OR 0.34, 95% CI 0.19 to 0.60; NNTB 4, 95% CI 3 to 8). AUTHORS' CONCLUSIONS There is insufficient evidence to decide whether OTC medications for cough associated with acute pneumonia are beneficial. Mucolytics may be beneficial but there is insufficient evidence to recommend them as an adjunctive treatment for acute pneumonia. This leaves only theoretical recommendations that OTC medications containing codeine and antihistamines should not be used in young children.
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Affiliation(s)
- Christina C Chang
- Infectious Diseases Unit, The Alfred Hospital, Monash University, Prahran, Australia.
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Teoh L, Hurwitz M, Acworth JP, van Asperen P, Chang AB. Treatment of obstructive sleep apnoea for chronic cough in children. Cochrane Database Syst Rev 2011:CD008182. [PMID: 21491406 DOI: 10.1002/14651858.cd008182.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood obstructive sleep apnoea (OSA) is a disorder that is characterised by repeated episodes of partial or complete upper airway obstruction (UAO) during sleep that result in disruption of normal ventilation and sleep patterns. Chronic cough in children is a significant medical problem and in some situations warrants thorough investigation. There may be an association between chronic cough and OSA as suggested in adult studies. OBJECTIVES To evaluate the efficacy of treatment of OSA leading to the resolution of cough in the management of children with chronic cough. SEARCH STRATEGY We searched the Cochrane Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE and EMBASE. The latest search was performed in September 2010. SELECTION CRITERIA All randomised controlled trials comparing an intervention for OSA to a control group (placebo or usual treatment) in children with chronic cough. DATA COLLECTION AND ANALYSIS We reviewed the search results against the pre-determined criteria for inclusion. Two review authors independently selected the studies. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS We found no randomised controlled trials that examined the efficacy of treatment of OSA in the management of children with chronic cough. AUTHORS' CONCLUSIONS There is currently no evidence that therapies directed for OSA are useful for the management of chronic cough in children. Until further evidence is available, OSA should be managed on its own merits and the presence or absence of cough should not be used as a decision trigger. Further research examining the effects of this intervention is needed.
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Affiliation(s)
- Laurel Teoh
- Department of Paediatrics & Child Health, The Canberra Hospital, PO Box 11, Woden, Canberra, ACT, Australia, 2606
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Catania MA, Cuzzocrea S. Pharmacological and clinical overview of cloperastine in treatment of cough. Ther Clin Risk Manag 2011; 7:83-92. [PMID: 21445282 PMCID: PMC3061847 DOI: 10.2147/tcrm.s16643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Indexed: 11/23/2022] Open
Abstract
Cough constitutes an impressive expression of the normal defense mechanisms of the respiratory system. Productive cough associated with catarrh is an important protective system for the lung because it favors the upward movement of secretions and foreign bodies to the larynx and mouth. Cough may also appear without bronchial secretions, as dry cough, which may be persistent when inflammatory disease is chronic or when, in the early stages of respiratory disease, bronchial secretions are not yet fluid. Sometimes bronchitis-induced cough does not significantly affect quality of life, whilst in other cases cough may become so intense as to impair daily activities severely, resulting in permanent disability. This type of cough is one of the most frequent reasons for seeking medical advice. The use of cough suppressants may be appropriate for reaching a precise diagnosis and when dry cough is persistent. Cloperastine has been investigated in various types of cough and, unlike codeine, has been shown to possess dual activity. It also acts as a mild bronchorelaxant and has antihistaminic activity, without acting on the central nervous system or the respiratory center. Here we review the preclinical and clinical evidence of the efficacy and tolerability of cloperastine.
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Affiliation(s)
- Maria Antonietta Catania
- Department of Clinical and Experimental Medicine and Pharmacology, School of Medicine, University of Messina
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Abstract
BACKGROUND Cough causes concern for parents and is a major cause of outpatient visits. It can impact on quality of life, cause anxiety and affect sleep in parents and children. Several remedies, including honey, have been used to alleviate cough symptoms. OBJECTIVES To evaluate the effectiveness of honey for acute cough in children in ambulatory settings. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 2) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (1950 to April Week 2 2009); EMBASE (1990 to April 2009); CINAHL (1982 to April 2009); Web of Science (2000 to April 2009); AMED (1985 to April 2009); and LILACS (1982 to April 2009). SELECTION CRITERIA Randomised controlled trials (RCT) comparing honey given alone or in combination with antibiotics versus nothing, placebo or other over-the-counter (OTC) cough medications to participants aged from two to 18 years for acute cough in ambulatory settings. DATA COLLECTION AND ANALYSIS Two review authors independently screened search results for eligible studies and extracted data on reported outcomes. Trial authors of the included study were contacted for additional information on unpublished data. MAIN RESULTS One RCT of 108 children with upper respiratory tract infections comparing the effect of honey, dextromethorphan and no treatment on cough and sleep quality for coughing children and their parents was included. Comparing symptoms and sleep quality scores of children that received honey with those that received no treatment showed that honey was more effective in reducing frequency of cough (mean difference (MD) -0.99; 95% CI -1.63 to -0.35, bothersome cough (MD -0.93; 95% CI -1.76 to -0.10), and sleep quality of the child (MD -0.92; 95% CI -1.77 to -0.07); but did not differ significantly between the honey versus no treatment groups in resolving severity of cough (MD -0.69; 95% CI -1.46 to 0.07) and sleep quality of the parents (MD 0.80; 95% CI -1.67 to 0.07). Dextromethorphan and honey did not differ significantly on cough frequency (MD -0.49; 95% CI -1.15 to 0.17); cough severity (MD -0.50; 95% CI -1.28 to 0.29), bothersome cough (MD -0.29; 95% CI -1.14 to 0.56) and sleep quality of the children (MD -0.70; 95% CI -1.57 to 0.17) or their parents (MD -0.34; 95% CI -1.24 to 0.55). AUTHORS' CONCLUSIONS We found insufficient evidence to advise for or against the use of honey for acute cough in children.
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Affiliation(s)
- Olabisi Oduwole
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, EHCARP, P.O. Box 3134, General Post Office, Calabar, Cross River State, Nigeria
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Russell K, Robinson J, Yorke D, Axelsson I. The Cochrane Library and Treatment for Community Acquired Pneumonia in Children: An Overview of Reviews. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/ebch.393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Chronic non-specific cough is a chronic, dry cough of in the absence of identifiable respiratory disease or known aetiology. Although it is usually not reflective of an underlying severe illness, it does cause significant morbidity, and as such relief from it is often sought. The use of honey and lozenges to soothe upper respiratory tract irritation is common, inexpensive, and potentially more effective in treating the symptoms than pharmacological interventions. OBJECTIVES To evaluate the efficacy of honey and/or lozenges in the management of children with chronic non-specific cough. SEARCH STRATEGY The Cochrane Airways Group searched the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, OLDMEDLINE, and EMBASE databases in October 2008. SELECTION CRITERIA All randomised controlled trials comparing honey or lozenges with a placebo in treating children with chronic non-specific cough. DATA COLLECTION AND ANALYSIS The results of the searches were assessed according to the pre-determined criteria. None of the trials identified by the searches were eligible for inclusion, leaving no data available for analysis in this review. MAIN RESULTS The search did not provide any applicable randomised controlled trials that investigated the efficacy of honey and lozenges in treating children with non-specific chronic cough. Data from acute studies suggest a potential role for honey in relieving cough, but whether this is applicable to chronic cough is unknown. AUTHORS' CONCLUSIONS Clinically, this review was unable to provide any justifiable recommendation for or against honey and/or lozenges due to the lack of evidence. The absence of applicable studies highlights the need for further research into the area of treating children with chronic non-specific coughs with honey and/or lozenges. These treatments are not recommended when managing very young children (as lozenges are a potential choking hazard, and honey may cause infant botulism in children under 1 year of age).
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Affiliation(s)
- Selamawit Mulholland
- Queensland Respiratory Centre, Royal Children's Hospital, Herston, Queensland, Australia.
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Abstract
Pneumonia is a leading killer of children in developing countries and results in significant morbidity worldwide. This article reviews the management of pneumonia and its complications from the perspective of both developed and resource-poor settings. In addition, evidence-based management of other respiratory infections, including tuberculosis, is discussed. Finally, the management of common complications of pneumonia is reviewed.
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Affiliation(s)
- Sarath C Ranganathan
- Department of Respiratory Medicine, Royal Children's Hospital Melbourne, Parkville, Melbourne, VIC 3052, Australia.
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Mulholland S, Chang AB. Honey and lozenges for children with non-specific cough. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Småbrekke L, Melbye H. Medikamentell behandling av akutt hoste. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:998-9. [DOI: 10.4045/tidsskr.08.0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2007:CD006088. [PMID: 17943884 DOI: 10.1002/14651858.cd006088.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants). These might provide relief in reducing the severity of cough, but conversely, suppression of the cough mechanism might impede airway clearance and cause harm. OBJECTIVES To evaluate the efficacy of OTC cough medications as an adjunct to antibiotics in children and adults with pneumonia. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2006, Issue 4); MEDLINE (January 1966 to December 2006); OLDMEDLINE (1950 to 1965); EMBASE (1980 to December 2006) and the list of references in relevant publications. SELECTION CRITERIA All randomised controlled trials (RCTs) in children and adults comparing any type of OTC cough medication with a placebo, or control medication, with cough as an outcome and where the cough is secondary to acute pneumonia. DATA COLLECTION AND ANALYSIS We independently selected trials for inclusion. Data were extracted from these studies, assessed for methodological quality without disagreement, and analysed using standard methods. MAIN RESULTS Four studies were included with a total of 224 participants; one was performed exclusively in children and three in adolescents or adults. One using an antitussive had no extractable pneumonia-specific data. Three different mucolytics (bromhexine, ambroxol, neltenexine) were used in the remaining studies, of which only two had extractable data. They demonstrated no significant difference for the primary outcome of 'not cured or not improved' for mucolytics. A secondary outcome of 'not cured' was reduced (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.16 to 0.77; number needed to treat (NNT) 5, 95% CI 3 to 16 for children and OR 0.32, 95% CI 0.13 to 0.75; NNT 5, 95% CI 3 to 19 for adults). In a post hoc analysis combining data for children and adults, again there was also no difference in the primary outcome of 'not cured or not improved' (OR 0.85, 95% CI 0.40 to 1.80) although mucolytics reduced the secondary outcome 'not cured' (OR 0.33, 95% CI 0.19 to 0.60; NNT 4, 95% CI 3 to 8). AUTHORS' CONCLUSIONS There is insufficient evidence to decide whether OTC medications for cough associated with acute pneumonia are beneficial. Mucolytics may be, but there is insufficient evidence to recommend them as an adjunctive treatment of acute pneumonia. This leaves only theoretical recommendations that OTC medications containing codeine and antihistamines should not be used in young children.
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Affiliation(s)
- C C Chang
- Geelong Hospital, Infectious Diseases, 109 Station Street, Carlton, Victoria, Australia, 3053.
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