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Thomas RJ, Yerkovich ST, Goyal V, Chang AB, Rutter C, Masters IB, Marchant JM. The utility of elective flexible bronchoscopy to improve quality of life and clinical outcomes for children: A systematic review. Pediatr Pulmonol 2024; 59:1589-1595. [PMID: 38411339 DOI: 10.1002/ppul.26940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there is limited evidence regarding the utility of elective FB in children. This systematic review (SRs) aimed to determine the utility of FB on its impact in clinical decision making and quality of life (QoL). METHODS We searched Pubmed, Cochrane central register of controlled trials, Embase, World Health Organization Clinical Trials Registry Platform and Cochrane database of SRs from inception to April 20, 2023. We included SRs and randomized controlled trials (RCTs) that used parallel group design (comparing use of elective FB vs. no FB, or a wait-list approach [early FB vs. usual wait FB]) in children aged ≤ 18 years. Our protocol was prospectively registered and used Cochrane methodology for systemic reviews of interventions. RESULTS Our search identified 859 articles; 102 duplicates were removed, and 753 articles were excluded by title and abstract. Four full text articles were reviewed and subsequently excluded, as none met the inclusion criteria outlined in our patient, intervention, comparator, outcome measures framework. CONCLUSIONS There is a paucity of high-quality RCT evidence to support the routine use of elective FB in children with respiratory conditions. However, available retrospective and a single prospective study demonstrate the high utility of FB in the elective pediatric setting. REGISTRATION PROSPERO CRD42021291305.
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Affiliation(s)
- Rahul J Thomas
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Departments of Paediatrics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cameron Rutter
- Academic Division, Library, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Thomas R, Marchant JM, Goyal V, Masters IB, Yerkovich ST, Chang AB. Clinical utility of elective paediatric flexible bronchoscopy and impact on the quality of life: protocol for a single-centre, single-blind, randomised controlled trial. BMJ Open Respir Res 2024; 11:e001704. [PMID: 38413121 PMCID: PMC10900573 DOI: 10.1136/bmjresp-2023-001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Elective flexible bronchoscopy (FB) is now widely available and standard practice for a variety of indications in children with respiratory conditions. However, there are no randomised controlled trials (RCTs) that have examined its benefits (or otherwise).Our primary aim is to determine the impact of FB on the parent-proxy quality-of-life (QoL) scores. Our secondary aims are to determine if undertaking FB leads to (a) change in management and (b) improvement of other relevant patient-reported outcome measures (PROMs). We also quantified the benefits of elective FB (using 10-point Likert scale). We hypothesised that undertaking elective FB will contribute to accurate diagnosis and therefore appropriate treatment, which will in turn improve QoL and will be deemed to be beneficial from patient and doctor perspectives. METHODS AND ANALYSIS Our parallel single-centre, single-blind RCT (commenced in May 2020) has a planned sample size of 114 children (aged <18 years) recruited from respiratory clinics at Queensland Children's Hospital, Brisbane, Australia. Children are randomised (1:1 concealed allocation) within two strata: age (≤2 vs >2 years) and indication for FB (chronic cough vs other indications) to either (a) early arm (intervention where FB undertaken within 2 weeks) or (b) delayed (control, FB undertaken at usual wait time). Our primary outcome is the difference between groups in their change in QoL at the T2 timepoint when the intervention group has had the FB and the control group has not. Our secondary outcomes are change in management, change in PROMs, adverse events and the Likert scales. ETHICS AND DISSEMINATION The human research ethics committee of the Queensland Children's Hospital granted ethical clearance (HREC/20/QCHQ/62394). Our RCT is conducted in accordance with Good Clinical Practice and the Australian legislation. Results will be disseminated through conference presentations, teaching avenues, workshops, websites and publications. REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12620000610932.
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Affiliation(s)
- Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ian Brent Masters
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Stephanie T Yerkovich
- Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
| | - Anne B Chang
- Respiratory Medicine, Australian Centre for Health Services Innovation, Kelvin Grove, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Casuarina, Australia
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Divaret‐Chauveau A, Mauny F, Hose A, Depner M, Dalphin M, Kaulek V, Barnig C, Schaub B, Schmausser‐Hechfellner E, Renz H, Riedler J, Pekkanen J, Karvonen AM, Täubel M, Lauener R, Roduit C, Vuitton DA, von Mutius E, Demoulin‐Alexikova S, Kirjavainen P, Roponen M, Laurent L, Theodorou J, Böck A, Pechlivanis S, Ege M, Genuneit J, Illi S, Kabesch M, Pfefferle P, Frei R. Trajectories of cough without a cold in early childhood and associations with atopic diseases. Clin Exp Allergy 2022; 53:429-442. [PMID: 36453463 DOI: 10.1111/cea.14257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood. OBJECTIVES The objective of the study was to describe the latent class trajectories of cough from one to 10 years old and analyse their association with wheezing, atopy and allergic diseases. METHODS Questions about cough, wheeze and allergic diseases were asked at 1, 1.5, 2, 3, 4, 5, 6 and 10 years of age in the European prospective cohort of Protection against Allergy: STUdy in Rural Environment (PASTURE). Specific IgE assays were performed at 10 years of age. Questions regarding a cough without a cold were used to build a latent class model of cough over time. RESULTS Among the 961 children included in the study, apart from the never/infrequent trajectory (59.9%), eight trajectories of cough without a cold were identified: five grouped acute transient classes (24.1%), moderate transient (6.8%), late persistent (4.8%) and early persistent (4.4%). Compared with the never/infrequent trajectory, the other trajectories were significantly associated with wheezing, asthma and allergic rhinitis. For asthma, the strongest association was with the early persistent trajectory (ORa = 31.00 [14.03-68.51]), which was inversely associated with farm environment (ORa = 0.39 [0.19-0.77]) and had a high prevalence of cough triggers and unremitting wheeze. Late and early persistent trajectories were also associated with food allergy. Atopic sensitization was only associated with the late persistent trajectory. CONCLUSION Late and early persistent coughs without a cold are positively associated with atopic respiratory diseases and food allergy. Children having recurrent cough without a cold with night cough and triggers would benefit from an asthma and allergy assessment. Growing up on a farm is associated with reduced early persistent cough.
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Affiliation(s)
- Amandine Divaret‐Chauveau
- Paediatric Allergy Department University Hospital of Nancy Vandoeuvre‐les‐Nancy France
- EA3450 Développement Adaptation et Handicap (DevAH) University of Lorraine Nancy France
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
| | - Frederic Mauny
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
- Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique CIC Inserm 143, University Hospital of Besançon Besançon France
| | - Alexander Hose
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
| | - Martin Depner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | | | - Vincent Kaulek
- Respiratory Diseases Department University Hospital of Besançon Besançon France
| | - Cindy Barnig
- Respiratory Diseases Department University Hospital of Besançon Besançon France
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte‐Greffon‐Tumeur, Ingénierie Cellulaire et Génique Bourgogne Franche‐Comté University Besançon France
| | - Bianca Schaub
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
| | - Elisabeth Schmausser‐Hechfellner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | - Harald Renz
- Institute for Medicine Laboratory, Pathobiochemistry and Molecular Diagnostics Philipps‐University Marburg Marburg Germany
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology Sechenov University Moscow Russia
| | | | - Juha Pekkanen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
- Department of Public Health University of Helsinki Helsinki Finland
| | - Anne M. Karvonen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Martin Täubel
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Roger Lauener
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital of Eastern Switzerland St Gallen Switzerland
| | - Caroline Roduit
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- University Children's Hospital Zurich Zurich Switzerland
| | | | - Erika von Mutius
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
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Children's Acute Cough-Specific Quality of Life: Revalidation and Development of a Short Form. Lung 2021; 199:527-534. [PMID: 34623514 DOI: 10.1007/s00408-021-00482-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Acute cough in children has a significant impact on the child and family. Relevant quality of life (QoL) instruments are essential for high-quality clinical research. This study aimed to (1) revalidate the 16-item Parent-proxy Children's Acute Cough-specific QoL questionnaire (PAC-QoL16) using a different dataset (i.e., different children), (2) confirm the minimally important difference (MID), and (3) develop and validate a short form. METHODS Three datasets from two sources were utilized, comprising of 332 children with acute cough (< 2 weeks duration); the first dataset (n = 83, 54 boys; median age 2.04 years, IQR 1.08-4.06 years) was used for revalidation, the second dataset (n = 238, 141 boys; median age 2.17 years, IQR 1.21-4.21 years) was used to develop the short form, and the third dataset (n = 94, 62 boys; median age, 1.75 years, IQR 0.90-3.63 years) was used to confirm the short form. Psychometric properties were investigated. RESULTS Six items were found to account for 96.4% of the variance in the PAC-QoL16. The PAC-QoL16 and short form (PAC-QoL6) scales correlated with cough scores (rs ≤ - 0.40, p < 0.001), were internally consistent (Cronbach α = 0.94 and 0.87, respectively) and demonstrated sensitivity to change over time. A MID of 0.71 to 1.11 is recommended. CONCLUSION Both the PAC-QoL16 and newly developed short form (PAC-QoL6) are reliable and valid outcome measures that assess children's acute cough-specific QoL at a given time point, are easy to interpret and reflect changes over time. The new short form addresses the need for outcome measures to be as time effective as possible without loss of information.
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Cheng J, Mackie A, Chang AB, Grimwood K, Scott M, King A, Goyal V, Marchant JM, O'Grady KAF. Medication and healthcare use, parent knowledge and cough in children: A cohort study. Pediatr Pulmonol 2021; 56:2345-2354. [PMID: 33902157 DOI: 10.1002/ppul.25424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Cough is an important contributor to the health burden of children and their families. There are limited data describing healthcare utilization and medication use over the course of a cough illness beyond the initial presentation. Our primary objective was to describe medication and healthcare use in children with a respiratory illness with cough as a symptom over the course of the illness. METHODS A cohort study of children aged less than 15-years presenting to three primary healthcare centers and three emergency departments with a cough illness between July 7, 2015 and October 6, 2018. Children with immunosuppression, known chronic lung diseases (except asthma) and those requiring hospitalization at screening were excluded. The primary outcomes were cough-related frequency and type of healthcare seeking and medication use up to 28 days following enrolment. RESULTS Data for 465 children were analyzed; median age 2.2-years (interquartile range = 1.1-5.3). Cough at Day 28 persisted in 117 children (25.2%). Overall, 436 (94%) children received medications in the week before and/or 4 weeks following enrolment. Half with upper respiratory tract infections were prescribed antibiotics. Among children with no diagnosis of asthma, reactive airways disease or croup (n = 404), 16.8% were given steroids. Fifty-eight percent of children sought healthcare at least once before their baseline presentation (median = 1, range = 0-20) and 49.7% had at least one further presentation in the following 28 days. CONCLUSIONS High healthcare utilization, inappropriate medication use, and suboptimal parent knowledge regarding cough suggests targeted education is needed to improve management and reduce cough burden.
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Affiliation(s)
- Joan Cheng
- Somerville House, South Brisbane, Queensland, Australia
| | - Amelia Mackie
- Somerville House, South Brisbane, Queensland, Australia
| | - Anne B Chang
- Australian Health Services Institute, Center for Healthcare Transformation, Queensland University of Technology, South Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, Tiwi, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Department of Infectious Disease and Paediatrics, Gold Coast Health, Southport, Queensland, Australia
| | - Mark Scott
- Department of Emergency Medicine, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Alex King
- Department of Emergency Medicine, The Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Vikas Goyal
- Australian Health Services Institute, Center for Healthcare Transformation, Queensland University of Technology, South Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Julie M Marchant
- Australian Health Services Institute, Center for Healthcare Transformation, Queensland University of Technology, South Brisbane, Queensland, Australia.,Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Kerry-Ann F O'Grady
- Australian Health Services Institute, Center for Healthcare Transformation, Queensland University of Technology, South Brisbane, Queensland, Australia
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Koehler U, Hildebrandt O, Fischer P, Gross V, Sohrabi K, Timmesfeld N, Peter S, Urban C, Steiß JO, Koelsch S, Kerzel S, Weissflog A. Time course of nocturnal cough and wheezing in children with acute bronchitis monitored by lung sound analysis. Eur J Pediatr 2019; 178:1385-1394. [PMID: 31321530 PMCID: PMC6694092 DOI: 10.1007/s00431-019-03426-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/02/2022]
Abstract
Cough and wheezing are the predominant symptoms of acute bronchitis. Hitherto, the evaluation of respiratory symptoms was limited to subjective methods such as questionnaires. The main objective of this study was to objectively determine the time course of cough and wheezing in children with acute bronchitis. The impact of nocturnal cough on parent's quality of life was assessed as secondary outcome. In 36 children (2-8 years), the frequency of nocturnal cough and wheezing was recorded during three nights by automated lung sound monitoring. Additionally, parents completed symptom logs, i.e., the Bronchitis Severity Score (BSS), as well as the Parent-proxy Children's Acute Cough-specific Quality of Life Questionnaire (PAC-QoL). During the first night, patients had 34.4 ± 52.3 (mean ± SD) cough epochs, which were significantly reduced in night 5 (13.5 ± 26.5; p < 0.001) and night 9 (12.8 ± 28.1; p < 0.001). Twenty-two patients had concomitant wheezing, which declined within the observation period as well. All subjective parameters (BSS, Cough log and PAC-QoL) were found to be significantly correlated with the objectively assessed cough parameters.Conclusion: Long-term recording of cough and wheezing offers a useful opportunity to objectively evaluate the time course of respiratory symptoms in children with acute bronchitis. To assess putative effects of pharmacotherapy on nocturnal bronchitis symptoms, future studies in more homogeneous patient groups are needed. What is Known: • Cough and wheezing are the predominant symptoms of acute bronchitis. • There is a diagnostic gap in long-term assessment of these respiratory symptoms, which needs to be closed to optimize individual therapies. What is New: • Long-term recording of nocturnal cough and wheezing allows for objective evaluation of respiratory symptoms in children with acute bronchitis and provides a tool to validate the efficacy of symptomatic bronchitis therapies.
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Affiliation(s)
- Ulrich Koehler
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Olaf Hildebrandt
- Department of Internal Medicine, Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Gießen, Philipps-Universität, Baldingerstrasse 1, 35043 Marburg, Germany
| | - Patrick Fischer
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Volker Gross
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Gießen, Germany
| | - Nina Timmesfeld
- Department of Medicine, Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
| | - Saskia Peter
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
| | | | - Jens-Oliver Steiß
- Division of Pediatric Pulmonology and Allergy, Department of Pediatrics and Neonatology, University Hospital of Marburg and Gießen, Gießen, Germany
| | - Stephan Koelsch
- CHC Medical Affairs, Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Sebastian Kerzel
- Department of Pediatric Pneumology and Allergy, University Children’s Hospital Regensburg, St. Hedwig Campus, Regensburg, Germany
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Prentice B, Jaffé A. Antibiotics for prolonged wet cough in children. J Paediatr Child Health 2019; 55:110-113. [PMID: 30637868 DOI: 10.1111/jpc.14300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Bernadette Prentice
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine University of New South Wales, Sydney, New South Wales, Australia
| | - Adam Jaffé
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine University of New South Wales, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Cough is a frequent symptom presenting to doctors. The most common cause of childhood chronic (greater than fours weeks' duration) wet cough is protracted bacterial bronchitis (PBB) in some settings, although other more serious causes can also present this way. Timely and effective management of chronic wet or productive cough improves quality of life and clinical outcomes. Current international guidelines suggest a course of antibiotics is the first treatment of choice in the absence of signs or symptoms specific to an alternative diagnosis. This review sought to clarify the current evidence to support this recommendation. OBJECTIVES To determine the efficacy of antibiotics in treating children with prolonged wet cough (excluding children with bronchiectasis or other known underlying respiratory illness) and to assess risk of harm due to adverse events. SEARCH METHODS We undertook an updated search (from 2008 onwards) using the Cochrane Airways Group Specialised Register, Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trials registries, review articles and reference lists of relevant articles. The latest searches were performed in September 2017. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing antibiotics with a placebo or a control group in children with chronic wet cough. We excluded cluster and cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methods as recommended by Cochrane. We reviewed results of searches against predetermined criteria for inclusion. Two independent review authors selected, extracted and assessed the data for inclusion. We contacted authors of eligible studies for further information as needed. We analysed data as 'intention to treat.' MAIN RESULTS We identified three studies as eligible for inclusion in the review. Two were in the previous review and one new study was included. We considered the older studies to be at high or unclear risk of bias whereas we judged the newly included study at low risk of bias. The studies varied in treatment duration (from 7 to 14 days) and the antibiotic used (two studies used amoxicillin/clavulanate acid and one used erythromycin).We included 190 children (171 completed), mean ages ranged from 21 months to six years, in the meta-analyses. Analysis of all three trials (190 children) found that treatment with antibiotics reduced the proportion of children not cured at follow-up (primary outcome measure) (odds ratio (OR) 0.15, 95% confidence interval (CI) 0.07 to 0.31, using intention-to -treat analysis), which translated to a number needed to treat for an additional beneficial outcome (NNTB) of 3 (95% CI 2 to 4). We identified no significant heterogeneity (for both fixed-effect and random-effects model the I² statistic was 0%). Two older trials assessed progression of illness, defined by requirement for further antibiotics (125 children), which was significantly lower in the antibiotic group (OR 0.10, 95% CI 0.03 to 0.34; NNTB 4, 95% CI 3 to 5). All three trials (190 children) reported adverse events, which were not significantly increased in the antibiotic group compared to the control group (OR 1.88, 95% CI 0.62 to 5.69). We assessed the quality of evidence GRADE rating as moderate for all outcome measures, except adverse events which we assessed as low quality. AUTHORS' CONCLUSIONS Evidence suggests antibiotics are efficacious for the treatment of children with chronic wet cough (greater than four weeks) with an NNTB of three. However, antibiotics have adverse effects and this review reported only uncertainty as to the risk of increased adverse effects when they were used in this setting. The inclusion of a more robust study strengthened the previous Cochrane review and its results.
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Affiliation(s)
- Julie M Marchant
- Centre for Children's Health ResearchCough, Asthma, Airways Research GroupSouth BrisbaneAustralia
- Lady Cilento Children's HospitalDepartment of Respiratory and Sleep MedicineBrisbaneAustralia
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
| | - Helen L Petsky
- Griffith UniversitySchool of Nursing and Midwifery, Griffith University and Menzies Health Institute QueenslandBrisbaneQueenslandAustralia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoryAustralia0811
| | - Anne B Chang
- Centre for Children's Health ResearchCough, Asthma, Airways Research GroupSouth BrisbaneAustralia
- Lady Cilento Children's HospitalDepartment of Respiratory and Sleep MedicineBrisbaneAustralia
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoryAustralia0811
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Kardos P, Beeh KM, Sent U, Mueck T, Gräter H, Michel MC. Characterization of differential patient profiles and therapeutic responses of pharmacy customers for four ambroxol formulations. BMC Pharmacol Toxicol 2018; 19:40. [PMID: 29973292 PMCID: PMC6030777 DOI: 10.1186/s40360-018-0229-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background Ambroxol relieves cough symptoms based on its secretagogue, anti-inflammatory, anti-oxidant, anti-bacterial, anti-viral, immunomodulatory and local anesthetic effects. The present study was designed to explore differential patient profiles and efficacy against acute respiratory symptoms of four formulations registered as over-the-counter medicines. Methods Nine hundred sixty-five pharmacy customers purchasing one of four branded ambroxol formulations (extended release capsules, adult syrup, pediatric syrup and soft pastilles) filled a questionnaire including a patient-adapted version of the Bronchitis Severity Scale, several questions on degree of impairment by acute cough, time to onset of symptom relief and duration of treatment. Data on pediatric syrup users were entered by their parents. Based on the exploratory character of the study, no hypothesis-testing statistical analysis was applied. Results Users of the pediatric syrup and the pastilles reported somewhat less severe baseline symptoms. The patient-adapted Bronchitis Severity Scale proved feasible as a self-administered tool. Among BSS items, ambroxol formulations improved chest pain while coughing to the largest and sputum to smallest degree (− 75% vs. -40%). Reported efficacy was comparable among formulations with minor differences in favor of the pediatric syrup. Time to onset of symptom relief was less than 60 min in more than 90% of patients and occurred prior to known systemic tmax. Time to onset was the parameter with the greatest differences between formulations, being reported fastest with pastilles and pediatric syrup and, as expected, slowest with extended release capsules. All ambroxol formulations were well tolerated. Conclusions We conclude that over-the-counter formulations of ambroxol exhibit comparable user profiles and efficacy. Differences in speed of onset of symptom relief may involve not only those in systemic pharmacokinetics but also local anesthetic effects of immediate release formulations. Differences between pediatric and adult syrup may in part reflect reporting bias.
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Affiliation(s)
- Peter Kardos
- Group Practice, Center for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Frankfurt am Main, Germany
| | | | - Ulrike Sent
- Medical Affairs Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt-Hoechst, Germany
| | - Tobias Mueck
- Medical Affairs Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt-Hoechst, Germany
| | - Heidemarie Gräter
- Medical Affairs Consumer Healthcare, Sanofi-Aventis Deutschland GmbH, Frankfurt-Hoechst, Germany
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Obere Zahlbacher Str. 67, 55131, Mainz, Germany.
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Lovie-Toon YG, Chang AB, Newcombe PA, Vagenas D, Anderson-James S, Drescher BJ, Otim ME, O’Grady KAF. Longitudinal study of quality of life among children with acute respiratory infection and cough. Qual Life Res 2018; 27:891-903. [DOI: 10.1007/s11136-017-1779-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/25/2022]
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Chang AB. In search for the Holy Grail of cough guidelines. ANNALS OF TRANSLATIONAL MEDICINE 2017; 4:516. [PMID: 28149878 DOI: 10.21037/atm.2016.12.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Qld University of Technology, South Brisbane, Queensland 4101, Australia; ; Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Abstract
BACKGROUND Cough in children is a commonly experienced symptom that is associated with increased health service utilisation and burden to parents. The presence of chronic (equal to or more than four weeks) cough in children may indicate a serious underlying condition such as inhaled foreign body or bronchiectasis. Codeine (and derivative)-based medications are sometimes used to treat cough due to their antitussive properties. However, there are inherent risks associated with the use of these medications such as respiratory drive suppression, anaesthetic-induced anaphylaxis, and addiction. Metabolic response and dosage variability place children at increased risk of experiencing such side effects. A systematic review evaluating the quality of the available literature would be useful to inform management practices. OBJECTIVES To evaluate the safety and efficacy of codeine (and derivatives) in the treatment of chronic cough in children. SEARCH METHODS We searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1946 to 8 June 2016), EMBASE (1974 to 8 June 2016), the online trials registries of the World Health Organization and ClinicalTrials.gov, and the bibliographic references of publications. We imposed no language restrictions. SELECTION CRITERIA We considered studies eligible for analysis when: the participant population included children aged less than 18 years with chronic cough (duration equal to or more than four weeks at the time of intervention); and the study design evaluated codeine or codeine-based derivatives against placebo through a randomised controlled trial. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results to determine eligibility against a standardised criteria, and we had a pre-planned method for analysis. MAIN RESULTS We identified a total of 556 records, of which 486 records were excluded on the basis of title and abstract. We retrieved the remaining 70 references in full to determine eligibility. No studies fulfilled the inclusion criteria of this review, and thus we found no evidence to support or oppose the use of codeine or derivatives as antitussive agents for chronic cough in children.While chronic cough is not the same as acute cough, systematic reviews on the use of codeine efficacy for acute cough in children conclude an overall lack of evidence to support or oppose the use of over-the-counter cough and cold medications containing codeine (or derivatives) for treatment of acute cough in children. The lack of sufficient evidence to support the use of these medications has been consistently reaffirmed by medical experts in international chronic cough guidelines and by governing medical and pharmaceutical authorities in the USA, Europe, Canada, New Zealand, and Australia. Due to the lack of sufficient evidence to support efficacy, and the known risks associated with use - in particular the increased risks for children - these medications are now not recommended for children less than 12 years of age and children between 12 to 18 years with respiratory conditions. AUTHORS' CONCLUSIONS This review has highlighted the absence of any randomised controlled trials evaluating codeine-based medications in the treatment of childhood chronic cough. Given the potential adverse events of respiratory suppression and opioid toxicity, national therapeutic regulatory authorities recommend the contraindication of access to codeine in children less than 12 years of age. We suggest that clinical practice adhere to clinical practice guidelines and thus refrain from using codeine or its derivatives to treat cough in children. Aetiological-based management practices continue to be advocated for children with chronic cough.
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Affiliation(s)
- Samantha J Gardiner
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneQueenslandAustralia
| | - Anne B Chang
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneQueenslandAustralia
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
| | | | - Helen L Petsky
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneQueenslandAustralia
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