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At the heart of general practice since 1960

Practice's shock at death of out-of-hours pioneer

Beta2-agonists are 'widely used inappropriately' in children's respiratory disease, the authors of a new gold standard review conclude.

The Cochrane review found no evidence for using the drugs to treat cough in the absence of additional symptoms of airway obstruction.

The reviewers said children who did not truly have asthma were receiving medication they did not need ­ putting them at risk of side-effects.

'This review raises the appropriateness of the common practice of using inhaled ?2- agonists in children with cough without any other evidence of airway obstruction. There is nothing at present to suggest treatment with ?2-

agonists will be beneficial,' the researchers said.

Dr Ahmed Tomerak, paediatric specialist registrar at Torbay Hospital and the review's leader, told Pulse: 'It's clear they have to be limited or very restricted without a wheeze ailment. The evidence so far does not support the use of ?- agonists [in these cases]. I think it is very widely used inappropriately with chronic cough.'

He urged GPs to take a detailed history as previous wheeze or eczema would justify use of the drugs.

The review, published online in the latest issue of the Cochrane library, analysed 478 citations but identified only a single study that provided usable information on the use of ?2-agonists in children with non-specific chronic cough.

That study found no benefits for salbutamol over

placebo.

'Identifying children who are unlikely to benefit from medication could not only potentially prevent the diagnostic labelling of asthma in a large group of children but also save these children from the use of unnecessary medications and their associated side-effects,' the reviewers said.

Dr Dermot Ryan, member of the British Thoracic Society and a GP in Loughborough, Leicestershire, said it was not unreasonable to do a therapeutic trial with ?2-agonists, but treating a child with the drugs long-term 'does not make much sense'.

By Daniel Cressey

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