PURPOSE: Cough is one of the most frequent symptoms in children, affecting up to 25% of children of school and preschool age, and is one of the most common reasons for which children are visited by primary care pediatricians.
METHODS: Overall, 433 children requiring pediatrician consultation for acute cough due to upper respiratory tract infection were enrolled in this observational study. Cough epidemiology, sleep quality and antitussive treatment were evaluated. Cough severity and frequency were assessed at baseline and after 6 days through a questionnaire administered to parents. Multivariate analysis was performed on treatment outcomes.
RESULTS: The mean age of children was 6.1 years. Cough incidence was 12.2%. Cough disturbed sleep in 87.5% of children and 71% of parents. The number of children treated with peripheral antitussive (levodropropizine, n=101) was higher than with central cough suppressants (codeine and cloperastine, n=60). Both classes of drugs were effective in reducing cough intensity and frequency. However, the percentage of cough resolution was significantly higher with levodropropizine than with central antitussives (47% vs. 28% respectively, p=0.0012). The percentage of no change/worsening was only 3% for levodropropizine vs. 18% for central drugs. In any type of cough (dry, productive or mixed), multivariate analysis showed a much higher probability of cough resolution/improvement for levodropropizine (90-95%) vs. central antitussives (60-85%) vs. other therapy/no treatment (50-80%), independently from the use of antibiotics and concomitant diseases.
CONCLUSIONS: Cough significantly disturbed children and parents sleep. The peripheral antitussive levodropropizine was the most used drug by pediatricians for children cough treatment. A significant advantage was observed for levodropropizine in terms of higher cough resolution and lower unsuccessful treatment, independently from cough intensity. In multivariate analysis, levodropropizine showed the highest probability of cough resolution/improvement.
CLINICAL IMPLICATIONS: Empiric treatment with antitussive agents is often needed in children. Peripheral antitussive levodropropizine seems to be the best therapeutic option, while centrally acting cough suppressants, although largely used, have no consistent evidence of efficacy and there are increasing reports of association with serious adverse events in children.
DISCLOSURE: Alessandro Zanasi: Grant monies (from industry related sources): This project was founded by Dompé S.P.A.
Luigi Lanata: Employee: Dompé S.P.A.
Gianluca De Danieli: Employee: Dompé S.P.A.
Filippo Bernardi: Grant monies (from industry related sources): This project was founded by Dompé S.P.A.
Salvatore Cazzato: Grant monies (from industry related sources): This project was founded by Dompé S.P.A.
Francesco De Blasio: Grant monies (from industry related sources): this project was founded by Dompé S.P.A.
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