What cough medication is suitable for a child with asthma?

From the Guidelines

For a child with asthma who has a cough, it's best to avoid over-the-counter cough suppressants and instead focus on managing the underlying asthma. According to the most recent guidelines, such as those from the 2020 Chest guideline and expert panel report 1, over-the-counter cough medications have little to no benefit in controlling cough symptoms in children and may even pose risks of adverse events, including reported deaths from toxicity in young children.

Key Considerations

• The child's prescribed asthma medications, such as albuterol (typically 2 puffs every 4-6 hours as needed) or their regular controller medications like inhaled corticosteroids, should be used as directed to manage the underlying asthma.
• If the cough persists despite good asthma control, honey can be used for children over 1 year of age (½ to 1 teaspoon as needed), as suggested by the updated systematic review 1, which found honey to offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo.
• Staying hydrated with warm liquids and using a cool-mist humidifier in the child's room can also help soothe the throat and ease cough symptoms.
• It's crucial to avoid using codeine-containing medications due to the potential for serious side effects, including respiratory distress, as advised by the Chest guideline 1.

Monitoring and Next Steps

• If the cough is severe, persists more than a few days, or is accompanied by difficulty breathing, wheezing, or fever, contact the child's healthcare provider immediately as this could indicate an asthma flare-up requiring medical attention or a change in the asthma management plan.
• The decision to start or adjust long-term control therapy should be based on considerations of diagnosis and prognosis, as outlined in the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1.

From the FDA Drug Label

Warnings ... Ask a doctor before use if you have • chronic cough that lasts as occurs with smoking, asthma or emphysema Ask a doctor before use if you have • cough that occurs with too much phlegm (mucus)

The dextromethorphan (PO) cough medication may not be suitable for a child with asthma without consulting a doctor first, as it warns to ask a doctor before use if the child has a chronic cough that occurs with asthma. 2

From the Research

Cough Medication for Children with Asthma

• The most suitable cough medication for a child with asthma is not explicitly stated in the provided studies, but some studies suggest the use of bronchodilator medication as a trial to show symptomatic improvement 3, 4, 5.
• According to the 2007 National Asthma Education and Prevention Program (NAEPP) report, inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for children with persistent asthma symptoms 3, 4.
• Montelukast is approved for children ages ≥ 12 months and is often used for its ease of daily oral dosing 3, 4.
• For acute exacerbations of asthma in children, the use of intravenous magnesium sulfate has been shown to reduce hospital length of stay and the risk of hospital admission 6.
• The addition of inhaled anticholinergic agents to inhaled beta2-agonists has also been shown to reduce the risk of hospital admission 6.

Key Considerations

• It is essential to identify and avoid triggers that can exacerbate asthma symptoms, such as second-hand cigarette smoke exposure and allergens 3, 4.
• A detailed protocolized assessment may be necessary to determine the nature of the problem and personalize treatment for children with severe asthma 7.
• The use of biologicals, such as omalizumab and mepolizumab, may be considered for children with steroid-resistant Type 2 airway inflammation 7.

Treatment Options

• Bronchodilator syrup may be used as a trial to show symptomatic improvement in children with chronic or recurring cough 5.
• Inhaled corticosteroids (ICS) are recommended as the preferred daily controller therapy for children with persistent asthma symptoms 3, 4.
• Montelukast may be used for its ease of daily oral dosing 3, 4.
• Intravenous magnesium sulfate may be used to reduce hospital length of stay and the risk of hospital admission for acute exacerbations of asthma in children 6.