Salbutamol-Containing Cough Syrup in Children Under 4 Years with Wheezing
Salbutamol-containing cough syrup is not justified for use in children under 4 years with wheezing and should be avoided due to lack of proven efficacy and potential safety concerns. 1
Evidence Against Use of Salbutamol Cough Syrup
- The American Academy of Pediatrics and FDA recommend against using over-the-counter (OTC) cold medications, including cough syrups, in children under 4 years due to potential toxicity and lack of proven efficacy 1
- There is no evidence to support using β2-agonists (including salbutamol) in children with acute cough and no evidence of airflow obstruction 1
- Studies on inhaled salbutamol for wheezing in infants have shown no significant beneficial effect on either clinical symptoms or pulmonary function 2
Recommended Approach for Wheezing in Children Under 4
- For children aged 0-4 years with recurrent wheezing triggered by respiratory tract infections, the recommended approach is a short course of daily inhaled corticosteroids (ICS) at the onset of a respiratory tract infection with as-needed SABA for quick-relief therapy 3
- One recommended regimen is budesonide inhalation suspension, 1 mg, twice daily for 7-10 days at the first sign of respiratory tract infection-associated symptoms 3
- Inhaled salbutamol via metered-dose inhaler with spacer (MDI-S) has been shown to be more effective than nebulized salbutamol for acute wheezing episodes in young children 4
Important Considerations
- Salbutamol inhalation aerosol is only FDA-approved for children 4 years of age and older for the treatment or prevention of bronchospasm 5
- OTC cough medications, including those containing salbutamol, have been associated with significant morbidity and even mortality in young children 1
- Caregivers should be provided with clear written instructions on how to implement the recommended action plan at the onset of a respiratory infection 3
Common Pitfalls to Avoid
- Assuming that cough always represents asthma and treating with bronchodilators without evidence of airflow obstruction 1
- Using medications with potential for harm despite lack of evidence for efficacy 1
- Failing to monitor growth in children treated with intermittent ICS, as data regarding effects on growth are conflicting 3
Alternative Approaches
- For children with acute cough over 1 year of age, honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo 1
- For chronic cough (>4 weeks) with asthma features, a 2-4 week trial of inhaled corticosteroids may be considered under specialist guidance 1
In conclusion, salbutamol-containing cough syrup should not be used in children under 4 years with wheezing. Instead, for recurrent wheezing triggered by respiratory infections, a short course of daily ICS with as-needed SABA via appropriate delivery device (preferably MDI with spacer) is the recommended approach.