From the Guidelines
Promethazine is not recommended for treating cough in asthmatic children. While promethazine is an antihistamine with some cough-suppressing properties, it should be avoided in asthma patients, especially children, because it can thicken respiratory secretions and potentially worsen breathing difficulties 1. For asthmatic children with cough, the focus should be on controlling the underlying asthma with appropriate controller medications like inhaled corticosteroids and bronchodilators as prescribed by their healthcare provider.
Key Considerations
- If the cough is due to an asthma flare-up, using the child's rescue inhaler (typically albuterol) as directed is more appropriate.
- For nighttime cough relief, elevating the head of the bed, using a humidifier, and ensuring adequate hydration may help.
- If the cough persists despite good asthma control, the child should be evaluated by a healthcare provider as it could indicate inadequate asthma management, a respiratory infection, or another condition requiring specific treatment.
Evidence-Based Recommendations
- According to the guidelines for evaluating chronic cough in pediatrics, children with chronic cough require careful and systematic evaluation for the presence of specific diagnostic indicators 1.
- The management of non-specific cough in children should be based on etiology, and a trial of therapy may be appropriate in some cases, with follow-up and cessation of medications if there is no effect on the cough within an expected timeframe 1.
- Many over-the-counter cough medications, including those containing promethazine, are generally not recommended for young children due to limited efficacy and potential side effects 1.
From the FDA Drug Label
CONTRAINDICATIONS Promethazine hydrochloride tablets are contraindicated for use in pediatric patients less than two years of age. Promethazine hydrochloride tablets are contraindicated in comatose states, and in individuals known to be hypersensitive or to have had an idiosyncratic reaction to promethazine or to other phenothiazines. Antihistamines are contraindicated for use in the treatment of lower respiratory tract symptoms including asthma.
- Contraindication: Promethazine is contraindicated for use in the treatment of lower respiratory tract symptoms, including asthma.
- The FDA drug label advises against using promethazine in patients with asthma, making it an inappropriate choice for an asthmatic child with a cough 2.
From the Research
Asthma Treatment for Children
- The goal of asthma therapy is to keep children "symptom free" by preventing chronic symptoms, maintaining lung function, and allowing for normal daily activities 3, 4.
- Avoidance of triggers identified by history, such as second-hand cigarette smoke exposure and allergens identified by skin-prick testing, can significantly reduce symptoms 3, 4.
Medication Options
- Inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for persistent asthma 3, 4.
- Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing 3, 4.
- Long-acting beta-2 adrenergic agonists should only be used in combination with an ICS 3, 4.
- Combination treatment with both ICS and long-acting beta2-agonist provides greater asthma control than increasing the ICS dose alone 5, 6.
Promethazine for Asthmatic Child with Cough
- There is no direct evidence in the provided studies to support the use of promethazine for an asthmatic child with cough.
- However, the studies suggest that treatment of asthma should focus on controlling symptoms and preventing exacerbations using medications such as ICS, montelukast, and long-acting beta-2 adrenergic agonists 3, 4, 5, 6, 7.