Anti-reflux medications such as proton pump inhibitors have little or no value in the management of chronic cough in children, according to new expert guidelines.
An update to 2006 CHEST Pediatric Cough guideline, led by Professor Anne Chang of the Menzies School of Health Research in Darwin, concludes that a 4-8 week trial of treatment such as PPI may only be warranted in children with chronic cough who have symptoms of gastro-oesophageal reflux disease (GORD).
After conducting a series of systematic reviews of randomised controlled trials, the CHEST Expert Cough Panel found there was little evidence to address the question of whether treatment of GORD would help resolve chronic cough in children.
A meta-analysis of two RCTs showed no significant difference between the GORD treatment vs. placebo for cough resolution, and also noted that PPIs caused increased serious adverse events.
The group therefore concluded that treatments for GORD should not be used to treat chronic cough (>4 weeks) in children under 14 when there are no clinical features of reflux such as recurrent regurgitation, dystonic neck posturing in infants, or heartburn/epigastric pain in older children.
And even when children with chronic cough have symptoms of GORD the guidelines recommend that anti-reflux treatment only be used for management of these symptoms rather than solely as a treatment for chronic cough.