From the Guidelines
Bromfed is not recommended for asthmatic children with cough. Bromfed contains brompheniramine (an antihistamine) and pseudoephedrine (a decongestant), which are not effective for treating asthma and may actually worsen asthma symptoms by drying secretions and potentially causing thickened mucus. According to the most recent and highest quality study 1, the use of over-the-counter cough and cold medicines, including those containing antihistamines and decongestants like Bromfed, should not be prescribed for children under 6 years of age due to the lack of efficacy and potential for adverse events.
For an asthmatic child with cough, the appropriate treatment should focus on controlling the underlying asthma with medications such as:
- Inhaled short-acting beta-agonists (like albuterol) for quick relief
- Inhaled corticosteroids for long-term control if needed The typical albuterol dosing for children is 2 puffs every 4-6 hours as needed using a spacer device. If the cough persists despite good asthma control, consult with a healthcare provider as the child may need assessment for other conditions like post-nasal drip, gastroesophageal reflux, or respiratory infections. Cough suppressants are generally not recommended for asthmatic children as coughing is a protective mechanism to clear airways, and suppressing it could potentially mask worsening asthma symptoms.
Key considerations in managing chronic cough in children include:
- Defining chronic cough as the presence of daily cough of at least 4 weeks in duration 1
- Assessing the effect of cough on the child and the family
- Using pediatric-specific cough management protocols or algorithms
- Taking a systematic approach to determine the cause of the cough
- Basing management on the etiology of the cough, rather than using empirical treatments.
From the Research
Asthmatic Child with Cough
- The treatment of asthma in children aims to keep them "symptom free" by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities 2.
- For children with persistent asthma, inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy if impairment symptoms are present for >2 days/week or 2 nights/month 2.
- Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing 2.
- There is no direct evidence in the provided studies to support the use of Bromfed for an asthmatic child with cough.
- However, dextromethorphan, a component of Bromfed, has been studied for its antitussive efficacy in cough associated with acute upper respiratory tract infection, but the results showed little difference between dextromethorphan and placebo treatment 3.
- Another study found that a combination of bilastine, dextromethorphan, and phenylephrine was efficacious and safe in the treatment of acute dry cough due to a common cold or allergy, but this study was conducted in adults and adolescents, not children 4.
Considerations for Treatment
- The goal of asthma therapy is to prevent chronic symptoms, maintain lung function, and allow for normal daily activities 2.
- Avoidance of triggers, such as second-hand cigarette smoke exposure and allergens, can significantly reduce symptoms 2.
- Treatment of asthma in children should be done in a step-wise fashion to reduce symptom frequency and improve asthma control 5.