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Meta-Analysis
. 2014 Sep 22;2014(9):CD003257.
doi: 10.1002/14651858.CD003257.pub5.

Symptomatic treatment of the cough in whooping cough

Kay Wang  1 , Silvana Bettiol, Matthew J Thompson, Nia W Roberts, Rafael Perera, Carl J Heneghan, Anthony Harnden
Affiliations
Meta-Analysis

Symptomatic treatment of the cough in whooping cough

Kay Wang et al. Cochrane Database Syst Rev. .

Abstract

Background: Around 16 million cases of whooping cough (pertussis) occur worldwide each year, mostly in low-income countries. Much of the morbidity of whooping cough in children and adults is due to the effects of the paroxysmal cough. Cough treatments proposed include corticosteroids, beta2-adrenergic agonists, pertussis-specific immunoglobulin, antihistamines and possibly leukotriene receptor antagonists (LTRAs).

Objectives: To assess the effectiveness and safety of interventions to reduce the severity of paroxysmal cough in whooping cough in children and adults.

Search methods: We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, the Database of Abstracts of Reviews of Effects (DARE 2014, Issue 2), accessed from The Cochrane Library, MEDLINE (1950 to 30 January 2014), EMBASE (1980 to 30 January 2014), AMED (1985 to 30 January 2014), CINAHL (1980 to 30 January 2014) and LILACS (30 January 2014). We searched Current Controlled Trials to identify trials in progress.

Selection criteria: We selected randomised controlled trials (RCTs) and quasi-RCTs of any intervention (excluding antibiotics and vaccines) to suppress the cough in whooping cough.

Data collection and analysis: Two review authors (SB, MT) independently selected trials, extracted data and assessed the quality of each trial for this review in 2009. Two review authors (SB, KW) independently reviewed additional studies identified by the updated searches in 2012 and 2014. The primary outcome was frequency of paroxysms of coughing. Secondary outcomes were frequency of vomiting, frequency of whoop, frequency of cyanosis (turning blue), development of serious complications, mortality from any cause, side effects due to medication, admission to hospital and duration of hospital stay.

Main results: We included 12 trials of varying sample sizes (N = 9 to 135), mainly from high-income countries, including a total of 578 participants. Ten trials recruited children (N = 448 participants). Two trials recruited adolescents and adults (N = 130 participants). We considered only three trials to be of high methodological quality (one trial each of diphenhydramine, pertussis immunoglobulin and montelukast). Included studies did not show a statistically significant benefit for any of the interventions. Only six trials, including a total of 196 participants, reported data in sufficient detail for analysis. Diphenhydramine did not change coughing episodes; the mean difference (MD) of coughing spells per 24 hours was 1.9; 95% confidence interval (CI) -4.7 to 8.5 (N = 49 participants from one trial). One trial on pertussis immunoglobulin reported a possible mean reduction of -3.1 whoops per 24 hours (95% CI -6.2 to 0.02, N = 47 participants) but no change in hospital stay (MD -0.7 days; 95% CI -3.8 to 2.4, N = 46 participants). Dexamethasone did not show a clear decrease in length of hospital stay (MD -3.5 days; 95% CI -15.3 to 8.4, N = 11 participants from one trial) and salbutamol showed no change in coughing paroxysms per day (MD -0.2; 95% CI -4.1 to 3.7, N = 42 participants from two trials). Only one trial comparing pertussis immunoglobulin versus placebo (N = 47 participants) reported data on adverse events: 4.3% in the treatment group (rash) versus 5.3% in the placebo group (loose stools, pain and swelling at injection site).

Authors' conclusions: There is insufficient evidence to draw conclusions about the effectiveness of interventions for the cough in whooping cough. More high-quality trials are needed to assess the effectiveness of potential antitussive treatments in patients with whooping cough.

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Conflict of interest statement

Kay Wang, Rafael Perera and Anthony Harnden were investigators in a double‐blind randomised controlled trial of montelukast for the treatment of postinfectious cough in adults, a subgroup of whom had laboratory‐confirmed pertussis infection (Wang 2014). The trial was funded by the National Institute for Health Research (NIHR) School for Primary Care Research. Kay Wang was the Principal Investigator responsible for the day to day conduct of the trial, Rafael Perera oversaw the statistical analysis of trial data and Anthony Harnden was Chief Investigator of the trial. Some of the results from the trial are included in this review. Matthew Thompson: no conflicts of interest to declare. Carl Heneghan: no conflicts of interest to declare. Nia Wyn Roberts: no conflicts of interest to declare. Silvana Bettiol: no conflicts of interest to declare.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Antihistamines versus placebo, Outcome 1 Paroxysms of cough per 24 hours.
2.1
2.1. Analysis
Comparison 2 Pertussis immunoglobulin versus placebo, Outcome 1 Mean paroxysmal cough per hour.
2.2
2.2. Analysis
Comparison 2 Pertussis immunoglobulin versus placebo, Outcome 2 Mean number of whoops per day (first week).
2.3
2.3. Analysis
Comparison 2 Pertussis immunoglobulin versus placebo, Outcome 3 Mean whoops per hour.
2.4
2.4. Analysis
Comparison 2 Pertussis immunoglobulin versus placebo, Outcome 4 Duration of hospital stay (days).
3.1
3.1. Analysis
Comparison 3 Salbutamol versus placebo, Outcome 1 Paroxysms of cough per day.
4.1
4.1. Analysis
Comparison 4 Steroids versus placebo, Outcome 1 Duration of hospital stay (days).
See this image and copyright information in PMC

Update of

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References to other published versions of this review

Bettiol 2010
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