Arch Dis Child 1999;81:38-44 ( July )

Persistent nocturnal cough: randomised controlled trial of high dose inhaled corticosteroid

M J Davies, P Fuller, A Picciotto, S A McKenzie

Queen Elizabeth Hospital for Children, Royal Hospitals Trust, Hackney Road, London E2 8PS, UK

Correspondence to: Dr S A McKenzie, Queen Elizabeth Children's Services, Royal London Hospital, Whitechapel, London E1 1BB, UK.email: mckenzie{at}rhtch.demon.co.uk

Accepted 11 February, 1999

OBJECTIVETo investigate the effect of a short course of inhaled corticosteroid in the treatment of isolated and persistent nocturnal cough in children.
DESIGNRandomised double blind placebo controlled study.
SETTINGSubjects' homes in east London, England.
SUBJECTSConsecutively referred children, 1-10 years old, with persistent nocturnal cough.
INTERVENTIONSPlacebo or fluticasone propionate 1 mg twice daily for three nights and 500 µg twice daily for 11 nights. Videotaping of children at night: two nights' baseline, nights 3 and 4 after three days of inhaled corticosteroid, and nights 15 and 16.
MAIN OUTCOME MEASUREA fall in 75% of coughs from baseline.
RESULTS50 subjects were recruited. The median number of coughs in the baseline period for the inhaled corticosteroid group and placebo group were 92 and 71, respectively (p = 0.43) and, on nights 15 and 16, 8 and 36, respectively (p < 0.01). Compared to baseline, both groups of subjects improved significantly by nights 15 and 16 (p < 0.01; p < 0.01). Comparing the inhaled corticosteroid and placebo groups, coughs fell to a median of 22% and 57% of baseline totals on nights 3 and 4, respectively (p = 0.38), and 8% and 35% on nights 15 and 16, respectively (p = 0.02). 17 of 24 subjects on inhaled corticosteroid who completed the study and 8 of 23 on placebo improved by 75% after two weeks (p = 0.03).
CONCLUSIONSChildren with persistent nocturnal cough improve in two weeks after referral on placebo. There is a modest benefit from a two week course of high dose inhaled corticosteroid.

Key messages It is sometimes believed that children with recurrent or persistent cough have asthma and are prescribed asthma medication This study of a group of children with cough has shown that the cough gets better over two weeks and that inhaled corticosteroid, even in very high dosages, offers very little benefit

Keywords: persistent nocturnal cough; cough variant asthma; inhaled corticosteroid

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© 1999 by Archives of Disease in Childhood
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