Leukotriene receptor antagonist for prolonged non-specific cough in children: Cochrane systematic review

Abstract

Assessed as up to date: 2010/10/28

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 a variety of asthma medications. The leukotriene pathway is reported to be involved in the sensory (neurogenic) pathway, which is a mechanism thought to be involved in the pathogenesis of chronic cough.

Objectives

To evaluate the effectiveness of leukotriene receptor antagonist (LTRA) in treating children with prolonged non-specific cough.

Search strategy

The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were carried out in October 2010.

Selection criteria

All randomised controlled trials comparing LTRA with a placebo medication in children with non-specific cough.

Data collection and analysis

Results of searches were reviewed against pre-determined criteria for inclusion. Two eligible trials that utilised montelukast were identified but no data was available for meta-analysis. It was not possible to separate results from children with non-specific cough from those without in one study and in the second, the groups were very small (5 in montelukast group and one in placebo group).

Main results

There was no significant difference in all study endpoints between the montelukast and placebo groups (total N=256 plus 6 from second study).

Authors' conclusions

With the lack of evidence, the routine use of LRTA in treating children with non-specific cough cannot be recommended.

Author(s)

Chang Anne B, Winter Donna, Acworth Jason P

Summary

Leukotriene receptor antagonist for prolonged non-specific cough in children

Children with non-specific cough (dry and non-productive cough without any other respiratory symptom, sign or systemic illness) are commonly treated with a variety of medications to treat the symptom of cough. This review examined whether there was any evidence for using leukotriene receptor antagonist in children with non-specific cough. There were two randomised controlled trials that included, but was not restricted to, children with non-specific cough, whereby no significant advantage over placebo was found in both studies. There is no RCT evidence to support the routine use of leukotriene receptor antagonist for the symptom of non-specific cough in children. Further research examining the effects of this treatment using child appropriate cough outcome measures is needed.

Reviewer's Conclusions

Implications for practice

With the lack of evidence, the routine use of LRTA in treating children with non-specific cough cannot be recommended. If LTRA were to be trialled in these children, current cohort data suggest a clinical response (subjective cough severity) usually occurs within two weeks of therapy and definitely within three weeks.

Implications for research

Randomised controlled trials of LTRA to determine the effectiveness in treating children with non-specific cough are clearly needed. Trials should be parallel studies and double blinded, given the known problems in studying cough, specifically the large placebo and time period effects. Based on cohort data, a short trial of three weeks would suffice. Outcome measures for the clinical studies on cough should be clearly defined using validated subjective data (including quality of life) and supported by objective data if possible.

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