Related Experiment Video
Updated: Aug 16, 2026
Establishment of a Mouse Model with Cough Hypersensitivity via Inhalation of Citric Acid
Published on: January 10, 2025
Methylxanthines for prolonged non-specific cough in children
A B Chang1, R A Halstead, H L Petsky
1Respiratory Medicine, Royal Children's Hospital, Herston, Brisbane, Queensland, Australia, 4029. annechang@ausdoctors.net
Insights
No randomized controlled trials support using methylxanthines for children's non-specific cough. Limited data suggest potential symptom improvement, but risks of toxicity outweigh benefits, necessitating further research.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Evidence-Based Medicine
Background:
- Non-specific cough is a common pediatric issue often treated with asthma medications.
- Methylxanthines, historically used for pediatric asthma, are still employed in some regions.
- These medications have modest bronchodilator effects and other pharmacological properties.
Purpose of the Study:
- To evaluate the efficacy of methylxanthines in treating children with non-specific cough.
Main Methods:
- Searched major databases (CENTRAL, MEDLINE, EMBASE) up to January 2005.
- Included randomized controlled trials comparing methylxanthines to placebo in children with non-specific cough.
- No eligible randomized controlled trials were identified; four non-randomized trials were reported.
Main Results:
- No randomized controlled trials (RCTs) were found for methylxanthine efficacy in non-specific cough.
- Non-randomized trials indicated a potential significant effect within 2-14 days of therapy.
Conclusions:
- Reliable evidence is lacking for routine methylxanthine use in pediatric non-specific cough.
- Limited data suggest a possible clinical response within 2-14 days.
- Methylxanthine use must consider toxicity risks and narrow therapeutic range; further research is needed.
Background:
Non-specific cough is defined as non-productive cough in the absence of identifiable respiratory disease or known aetiology. It is commonly seen in paediatric practice. These children are treated with a variety of therapies including a variety of asthma medications. Methylxanthines, the main medication used for paediatric asthma for many decades in Western countries, is still widely used in non-Western countries. Also, methylxanthines have other pharmacological properties and their bronchodilator effect is only modest.
Objectives:
To evaluate the efficacy of methylxanthines in treating children with non-specific cough.
Search Strategy:
The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register Collaboration and Cochrane Airways Group, MEDLINE and EMBASE databases were searched by the Cochrane Airways Group. The latest searches were performed in Jan 2005.
Selection Criteria:
All randomised controlled trials comparing methylxanthines with a placebo medication in treating children with non-specific cough.
Data Collection And Analysis:
Results of searches were reviewed against pre-determined criteria for inclusion. No eligible trials were identified and thus no data were available for analysis. Four small non-randomised controlled trials were reported.
Main Results:
No randomised controlled trials that examined the efficacy of methylxanthines in the management of prolonged non-specific cough in children were found. In the non randomised trials above, a significant effect was seen within 2-14 days of therapy.
Authors' Conclusions:
There is currently an absence of reliable evidence to support the routine use of methylxanthines for symptomatic control of non-specific cough in children. If methylxanthines were to be trialled in children with prolonged non-specific cough, cohort data (thus limited) suggest a clinical response (subjective cough severity) would be seen within 2-5 days (and certainly within 14 days) of therapy. However methylxanthine use has to be balanced against the well known risk of toxicity and its low therapeutic range in children. Further research examining the efficacy of this intervention is needed.
Related Concept Videos
01:23Upper Respiratory Drugs: Antitussives, Expectorants, and Mucolytics
Antitussives include codeine, dextromethorphan (Robitussin), and benzonatate (Tessalon). Codeine and dextromethorphan exert their effects centrally by suppressing the cough reflex center in the medulla. Benzonatate operates peripherally within the respiratory tract by anesthetizing...
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...
01:28Adrenergic Agonists: Mixed-Action Agents
Ephedrine and pseudoephedrine lack a catecholamine group, making them less susceptible to degradation by metabolic enzymes. They have increased oral bioavailability and lipophilicity, resulting in a longer duration of action. Their response is reduced by...
01:11Direct-Acting Cholinergic Agonists: Therapeutic Uses
01:20Antiasthma Drugs: Muscarinic Receptor Antagonists
Antimuscarinic agents compete with ACh for the same binding site on the muscarinic receptors. By binding to these receptors, they inhibit the downstream effects of ACh and block the parasympathetic...
01:16Drugs Used in Upper Respiratory Disorders: Overview
Antihistamines (e.g., Benadryl) block histamines from binding. Histamines are chemicals released during an allergic reaction in the body. As a...