What cough medication is suitable for an asthmatic child with a cough?

From the Guidelines

For a child with asthma who has a cough, I strongly recommend consulting with their pediatrician or asthma specialist before using any over-the-counter cough medications, and instead, focus on managing the underlying asthma with prescribed controller medications and rescue inhalers, as well as using honey to soothe cough symptoms, as evidenced by 1 and 1. The most recent and highest quality studies, such as 1 and 1, suggest that over-the-counter cough medications may interact with asthma medications or worsen respiratory symptoms, and therefore, should be avoided.

• Key considerations for managing cough in asthmatic children include:
  • Avoiding over-the-counter cough suppressants and antihistamines due to potential interactions with asthma medications or worsening of respiratory symptoms, as stated in 1 and 1
  • Focusing on managing underlying asthma with prescribed controller medications, such as inhaled corticosteroids, and rescue inhalers, like albuterol, as directed by their healthcare provider, as recommended in 1
  • Using honey (1 teaspoon for children over 1 year old) to safely soothe cough symptoms, as suggested in the example answer
  • Keeping the child well-hydrated, using a cool-mist humidifier, and elevating the head of the bed to reduce coughing, as mentioned in the example answer
  • Monitoring peak flow measurements (if age-appropriate) and recognizing early warning signs of an asthma flare-up, as emphasized in 1
  • Remembering that children under 4 years should not receive over-the-counter cough medications, and those with asthma require special consideration regardless of age, as stated in 1 and 1 It is essential to prioritize the child's asthma management and avoid using over-the-counter cough medications that may exacerbate their condition, as highlighted in 1 and 1.

From the FDA Drug Label

In controlled clinical trials, most patients exhibited an onset of improvement in pulmonary function within 5 minutes as determined by FEV1. Published reports of trials in asthmatic children aged 3 years or older have demonstrated significant improvement in either FEV1 or PEFR within 2 to 20 minutes following a single dose of albuterol inhalation solution An increase of 15% or more in baseline FEV1 has been observed in children aged 5 to 11 years up to 6 hours after treatment with doses of 0. 10 mg/kg or higher of albuterol inhalation solution.

For an asthmatic child with cough, albuterol (INH) can be used as it has been shown to improve pulmonary function in asthmatic children.

• The recommended dose is not specified in the provided text, but it is mentioned that doses of 0.10 mg/kg or higher of albuterol inhalation solution have been effective in children aged 5 to 11 years.
• Key benefits of albuterol include rapid onset of action (within 5 minutes) and significant improvement in pulmonary function (as measured by FEV1) that can last up to 6 hours.
• Important consideration: the text does not specifically address the treatment of cough in asthmatic children, but rather the improvement of pulmonary function in general. 2

From the Research

Cough Medication for Asthmatic Children

• Asthmatic children often experience cough as a symptom, which can be triggered by various factors such as viral upper respiratory infections, activity, or changes in weather 3.
• 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.
• For asthmatic children with cough, inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy if impairment symptoms are present for >2 days/week or 2 nights/month 3.
• Montelukast, a leukotriene receptor antagonist (LTRA), is approved for children ages ≥ 12 months and can be used as an alternative therapy for cough variant asthma (CVA) 4.
• LTRAs, such as montelukast, have been shown to exert anti-inflammatory effects and can reduce cough symptoms in asthmatic children 4.
• However, the effectiveness of LTRAs compared to ICSs as initial maintenance therapy is still a topic of debate, with some studies suggesting that ICSs are more effective in improving lung function and reducing symptoms 5.

Treatment Options

• Inhaled corticosteroids (ICSs) are considered the cornerstone of asthma therapy and are more effective than LTRAs in improving lung function and reducing symptoms 5.
• Combination therapy with ICSs and a long-acting beta2-agonist may be a more effective option for managing persistent asthma than treatment with a single-controller agent alone (ICS or LTRA) 5.
• As-needed use of albuterol-budesonide has been shown to result in a significantly lower risk of severe asthma exacerbation than as-needed use of albuterol alone among patients with mild asthma 6.

Considerations for Asthmatic Children

• Diagnosing asthma in toddlers with recurrent wheezing can be challenging, and treatment should be tailored to the individual child's needs 7.
• Treating asthma in a step-wise fashion usually reduces symptom frequency and improves asthma control 7.
• Asthma exacerbations and poor outcomes from acute exacerbations remain an area where improvement is needed, and primary care providers play a crucial role in managing childhood asthma 7.