Pediatric Respiratory Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
Allergy Center, Istituto Giannina Gaslini, Genoa, Italy.
Paediatr Drugs. 2020 Dec;22(6):617-634. doi: 10.1007/s40272-020-00420-4.
Cough is a widespread symptom in children and adolescents. Despite advances in scientific knowledge about the neurophysiological mechanisms underlying the cough reflex, the best therapeutic approaches for children and adolescents who cough remain unclear, and many needs are still unmet. Many remedies for cough are self-prescribed, reflecting strong demand, but significant evidence of their efficacy and safety is missing in pediatric populations. Moreover, as most coughs are part of self-limited illnesses, treatment could be considered unnecessary in some patients. Drug therapy to relieve cough and other symptoms is an essential part of treating a child with cough. However, unfortunately, the number of studies in each category of cough medications is minimal, and dosing and treatment duration varies significantly among studies. Some treatments have been shown to be no more effective than placebo. Lack of clear indications for dosing and treatment duration, the number of available drugs, the numerous active ingredients in products, and multiple caregivers administering medication to children have been considered contributors to an increased risk of inappropriate prescribing, accidental overdosing, and adverse events. This review presents the most recent evidence on the safety and efficacy of available cough remedies, focusing on the pediatric age group, and includes H receptor antagonists, mucolytics and expectorants, drugs acting peripherally on the cough reflex, drugs acting centrally on the cough reflex, drugs acting both peripherally and centrally on the cough reflex, and other compounds, including menthol, glycerol, honey, and medical devices composed of complex natural substances. Future perspectives on new therapeutic targets are also discussed.
咳嗽是儿童和青少年中普遍存在的症状。尽管在咳嗽反射的神经生理机制方面的科学知识取得了进展，但针对咳嗽儿童和青少年的最佳治疗方法仍不清楚，许多需求仍未得到满足。许多咳嗽的治疗方法都是自行开方的，这反映出需求强烈，但在儿科人群中，这些方法的疗效和安全性的大量证据仍然缺失。此外，由于大多数咳嗽是自限性疾病的一部分，因此在某些患者中，治疗可能被认为是不必要的。缓解咳嗽和其他症状的药物治疗是治疗咳嗽儿童的重要组成部分。然而，不幸的是，每类咳嗽药物的研究数量都很少，并且研究之间的剂量和治疗持续时间差异很大。一些治疗方法已被证明并不比安慰剂更有效。剂量和治疗持续时间的指示不明确、可用药物的数量、产品中的多种有效成分以及多位照顾者给儿童用药，这些都被认为是导致不适当处方、意外过量用药和不良事件风险增加的原因。本综述介绍了现有咳嗽缓解药物的安全性和疗效的最新证据，重点关注儿科年龄组，包括 H 受体拮抗剂、黏液溶解剂和祛痰剂、作用于咳嗽反射外周的药物、作用于咳嗽反射中枢的药物、同时作用于咳嗽反射外周和中枢的药物以及其他化合物，包括薄荷醇、甘油、蜂蜜和由复杂天然物质组成的医疗设备。还讨论了针对新治疗靶点的未来展望。
