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Symptomatic treatment of the cough in whooping cough

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Abstract

Background

Whooping cough is an important cause of childhood morbidity and mortality. There are 20 to 40 million cases of whooping cough annually world‐wide, 90% of which occur in developing countries, resulting in an estimated 200 to 300 000 fatalities each year. Much of the morbidity is due to the effects of the paroxysmal cough. Corticosteroids, salbutamol (beta 2 ‐ adrenergic stimulant), and pertussis‐specific immunoglobulin have been proposed as standard treatment for the cough. Antihistamines have also been administered. No systematic review of the effectiveness of any of these interventions or others has been performed.

Objectives

To assess the effectiveness and safety of interventions used to reduce the severity of the coughing paroxysms in whooping cough in children and adults.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 2, 2003); MEDLINE (January 1966 to June 2003); EMBASE (1990 to June 2003) and LILACS (1982 to November 2001). We also scanned reference lists of identified trials and contacted authors of identified trials and relevant pharmaceutical companies.

Selection criteria

Randomised and quasi‐randomised controlled trials of any intervention aimed at suppressing the cough in whooping cough; excluding antibiotics and vaccines.

Data collection and analysis

Two reviewers independently selected studies and extracted data. Our primary outcome was frequency of paroxysms of coughing. Secondary outcomes were frequency of vomiting, frequency of whoop, frequency of cyanosis, development of serious complications, mortality from any cause, side effects due to medication, admission to hospital and duration of hospital stay. Disagreements were resolved by discussion.

Main results

Nine studies satisfied the inclusion criteria but four had insufficient data for meta ‐ analysis of pre‐specified outcomes. Studies were small and poorly reported. The largest study had a sample size of 49 and the smallest study 18. All studies were performed in industrialised settings.

Eligible studies assessed diphenhyramine, pertussis immunoglobulin, dexamethasone and salbutamol. No statistically significant benefit was found for any of the interventions. Diphenhydramine did not change coughing spells (mean increase of coughing spells per 24 hours 1.9 with 95%CI ‐ 4.7 to 8.5) and pertussis immunoglobulin no change in hospital stay (0.7 days 95% CI ‐3.8 to 2.4), and a mean reduction of 3.1 whoops per 24 hours [95% CI ‐6.2; 0.02]. Dexamethasone did not show a clear decrease in hospital stay (‐3.5 days 95% CI ‐ 15.3 to 8.4) and salbutamol showed no change in coughing paroxysms per 24 hours [‐0.22 95% CI ‐ 4.13 to 3.69].

Authors' conclusions

Insufficient evidence exists to draw conclusions about the effects of any intervention for the cough in whooping cough.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

No strong evidence exists of any treatment that can relieve the serious cough caused by whooping cough, although there is some evidence that immunoglobulin might help

Whooping cough (pertussis) is sometimes life‐threatening. It is caused by a bacteria that usually affects babies and small children more severely. Immunisation can prevent it. Babies with whooping cough experience severe bouts of coughing, often leading to vomiting, malnutrition and dehydration. Treatment with corticosteroids, salbutamol, pertussis specific immunoglobulin (antibodies to increase the body's resistance) or antihistamines aims to reduce the cough while the disease runs its course. The review of trials found there is not enough evidence that these drugs can reduce the cough in whooping cough. Injections of pertussis specific immunoglobulin may be able to reduce coughs, but more research is needed.