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Treatment of the cough in whooping cough

Wang K, Bettiol S, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A
Published Online: 
22 September 2014

Review question

We reviewed the evidence from 12 studies about the effect of treatments for cough in patients with whooping cough.

Background

We wanted to discover whether any medicines are effective at treating cough in patients with whooping cough (also known as pertussis). These medicines included pertussis immunoglobulin (antibodies to increase the body's resistance to whooping cough) and treatments already used to treat symptoms of asthma and hay fever (antihistamines, salbutamol, steroids). Patients with whooping cough may experience severe coughing bouts. These may be accompanied by whooping (the sound made when taking a deep breath in after coughing) and vomiting, which can lead to dehydration, difficulty breathing and being admitted to hospital. We aimed to find out whether any medicines are effective at reducing coughing bouts in patients with whooping cough. We also aimed to find out whether any medicines reduced whooping, vomiting, cyanosis (turning blue because of lack of oxygen), serious complications (such as strokes and seizures), admission to hospital, time spent in hospital or death (from any cause). In addition, we looked at possible side effects of the medicines.

Study characteristics

The evidence in this review is current up to January 2014. We included 12 studies, which included a total of 578 participants. Ten studies involved a total of 448 children and two involved a total of 130 adolescents and adults. Five studies did laboratory tests to confirm the presence of whooping cough in all participants who took part. Nine studies compared the medicine to a placebo (i.e. a 'dummy' medicine which did not contain the active ingredient being studied) and three studies compared the medicine to no treatment. Seven studies involved hospital inpatients. Three studies reported their start and finish dates; one study recruited participants over 14 months, another over 18 months and another over 31 months.

Key results

Six studies including 196 participants reported their results in enough detail for us to assess them. Based on these results, antihistamines (one study, 49 participants), pertussis immunoglobulin (one study, 24 participants) and salbutamol (two studies, 42 participants) did not reduce the number of coughing bouts in patients with whooping cough. Neither pertussis immunoglobulin (one study, 46 participants) nor steroids (one study, 11 participants) decreased the length of time participants spent in hospital. One study reported similar rates of side effects in participants treated with pertussis immunoglobulin (4%; rash) or placebo (5%; loose stools, pain and swelling of the skin around where the injection was given). Studies of antihistamines, salbutamol and steroids did not report any results on side effects. None of these six studies reported any results on vomiting, cyanosis, serious complications, death or admission to hospital.

Quality of the evidence

Overall, the quality of evidence was low and many of the studies were conducted some years ago. Only three trials reported adequate details of how the type of treatment given was properly concealed from both participants and healthcare professionals. Methods of recording numbers of coughing bouts and whoops also differed between studies. Estimates of the effects of the different treatments were imprecise due to the small numbers of participants from whom results were available. Additionally, these results may not be generalisable to adults or community settings, since most studies involved children and were done in hospital inpatient settings.

This record should be cited as: 
Wang K, Bettiol S, Thompson MJ, Roberts NW, Perera R, Heneghan CJ, Harnden A. Symptomatic treatment of the cough in whooping cough. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD003257. DOI: 10.1002/14651858.CD003257.pub5
Assessed as up to date: 
30 January 2014