Over the Effect of No benefit of Honey preparations cough medications honey antitussives, should be tried on an preparations antihistamines, individual patient studied in basis, prior to opioids. children aged and 1-5 years with Consider guaifenesin nocturnal combinations in preparations if a cough and children with acute cough protussive is required. sleep (58). Guaifenesin may be disturbance an effective protussant secondary to (56, 60). Evidence for upper benefit of honey respiratory preparations over tract infection placebo, although not studied in palliative care patients (59). Sodium cromoglycate A single-arm In adults with advanced Based on open trial in cancer this was more recommendations for children with effective than placebo adults, could be tried chronic cough (61) and has been in children prior to (62) recommended for adults commencing opioids. prior to commencing opioids (55). Inhaled local No Evidence of benefit in Not recommended anaesthetics adult patients (63) due to insufficient evidence in children and risk of bronchoconstriction and aspiration secondary to local anaesthesia Nebulised saline Children with Saline effective but in Nebulised saline or solutions and DNase cystic fibrosis, adult studies less so than DNAse can be tried on but not hypertonic saline (64). an individual patient specifically Mucolytics such as basis for children with looking at Dnase are more effective thick secretions and/or effect on than saline (65) insufficient cough cough strength to remove secretions from airway. Mechanical Children with Mechanical Mechanical insufflation/exsufflation weakness can increase peak cough should be flow and improve considered as an secretion clearance adjunct to chest physiotherapy in children with insufficient cough strength to remove secretions from airway. Table 4: Symptomatic management of haemoptysis
Over the cough medications Effect of honey preparations studied in children aged 1-5 years with nocturnal cough and sleep disturbance secondary to upper respiratory tract infection No benefit of antitussives, antihistamines, and combinations in children with acute cough (58). Guaifenesin may be an effective protussant (56, 60). Evidence for benefit of honey preparations over placebo, although not studied in palliative care patients (59). Honey preparations should be tried on an individual patient basis, prior to opioids. Consider guaifenesin preparations if a protussive is required. Sodium cromoglycate A single-arm open trial in children with chronic cough (62) In adults with advanced cancer this was more effective than placebo (61) and has been recommended for adults prior to commencing opioids (55). Based on recommendations for adults, could be tried in children prior to commencing opioids. Inhaled local anaesthetics No Evidence of benefit in adult patients (63) Not recommended due to insufficient evidence in children and risk of bronchoconstriction and aspiration secondary to local anaesthesia Nebulised saline solutions and DNase Children with cystic fibrosis, but not specifically looking at effect on cough Saline effective but in adult studies less so than hypertonic saline (64). Mucolytics such as Dnase are more effective than saline (65) Nebulised saline or DNAse can be tried on an individual patient basis for children with thick secretions and/or insufficient cough strength to remove secretions from airway. Mechanical Children with weakness Mechanical insufflation/exsufflation can increase peak cough flow and improve secretion clearance Mechanical should be considered as an adjunct to chest physiotherapy in children with insufficient cough strength to remove secretions from airway. Table 4: Symptomatic management of haemoptysis