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Overuse of asthma medication in children with cough

Too many children are being prescribed asthma medication when they have a simple cough caused by recurrent infections, experts are warning.

In new guidance, the British Thoracic Society says there is increasing evidence children are being treated for asthma on the basis of cough without any other symptoms present.

A trial of asthma medication will not benefit most patients, the recommendations state.

And where it may be appropriate, for example in young children, treatment must be discontinued in the event of improvement.

The guidelines also reiterate advice that one in ten children with a viral infection will still be coughing three weeks later – and parents should be ad-vised the cough may take time to clear.

Dr Michael Shields, senior lecturer in the Department of Child Health at Queens Uni-versity Belfast said: 'People with non-specific cough are unlikely to have asthma – it seems like the majority have a post-viral type of cough.

'But a large number of children get put on asthma medication.

He added: 'When a trial of therapy is used and it works it must be stopped because the cough may have gone spontaneously.

'A lot of children are put on medication and then kept on it forever,' he said.

The recommendations say the prevalence of cough without colds in children is high – at around 30%.

Parents should be told that over the counter cough medicines are no better than placebo, the guidance says.

Dr Dermot Ryan, member of the General Practice Airways Group and GP in Leicestershire said diagnosis of asthma in the under fives was very difficult.

'There are times when a trial of asthma treatment is valid, but you have to stop the treatment again.

'It's also important not to increase the dose if the treat-ment is not having an effect but to review the diagnosis.'

He said under normal circumstances a child would have a cough for a couple of weeks and other symptoms of asthma would be present before a treatment trial is carried out.

'Nationally we are being more cautious about diagnos-ing asthma in the under fives but there will be some who haven't taken that message on board.'

The BTS guidelines on cough in children are published in Thorax.

Common causes of cough in children: red flag symptoms Common causes of cough in children: red flag symptoms

• neonatal onset,
• cough with feeding
• sudden onset cough,
• chronic moist cough with phlegm production
• associated night sweats/weight loss
• continuous unremitting or worsening cough
• signs of chronic lung disease.
Source: BTS Cough guidelines, Thorax

Asthma

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