Cochrane for Clinicians

Putting Evidence into Practice

Beta2 Agonists for Acute Cough or a Clinical Diagnosis of Acute Bronchitis

 

Am Fam Physician. 2017 May 1;95(9):551-552.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are beta2 agonists effective for improving symptoms of acute cough or a clinical diagnosis of acute bronchitis without wheeze?

Evidence-Based Answer

There is insufficient evidence to determine whether beta2 agonists can improve symptoms for children with acute cough or bronchitis with wheeze. Beta2 agonists are not likely to benefit and may cause adverse effects in adults who do not have evidence of airflow restriction (number needed to harm [NNH] = 2).1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Cough is a common reason patients seek acute ambulatory care, representing 2.8% of all U.S. office visits in 2012.2 In clinical practice, physicians are most likely to document a diagnosis of acute bronchitis when a patient has lower respiratory tract symptoms, primarily a chest cough, but no clinical evidence suggestive of pneumonia.3 Patients may receive inappropriate medications for acute bronchitis in part because of a discrepancy between patients' expectations of cough duration after an acute respiratory illness (five to nine days) and the typical duration of cough following a respiratory illness (18 days).4

This Cochrane review identified two trials of albuterol in children with acute cough.1 Children with wheezing or other evidence of airflow restriction for which bronchodilator therapy might be clinically indicated were excluded. The trials found no difference between albuterol and placebo in clinical improvement, meaning no decrease in the daily cough impact or number of children with cough. There was also no significant difference in adverse effects between patients given placebo and those given albuterol.

The authors identified five trials of beta2-agonist therapy in adults. When three of the trials were combined, they failed to show a significant difference between beta2 agonists and placebo in cough reduction (in these trials, 19% to 52% of patients had wheezing on initial ex

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Becker LA, Hom J, Villasis-Keever M, van der Wouden JC. Beta2-agonists for acute cough or a clinical diagnosis of acute bronchitis. Cochrane Database Syst Rev. 2015;(9):CD001726....

2. Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2012 state and national summary tables. http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2012_namcs_web_tables.pdf. Accessed May 10, 2016.

3. Hueston WJ, Mainous AG III, Dacus EN, Hopper JE. Does acute bronchitis really exist? A reconceptualization of acute viral respiratory infections. J Fam Pract. 2000;49(5):401–406.

4. Ebell MH, Lundgren J, Youngpairoj S. How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature. Ann Fam Med. 2013;11(1):5–13.

5. Snellman L, Adams W, Anderson G. et al. Diagnosis and treatment of respiratory illness in children and adults. Bloomington, Minn.: Institute for Clinical Systems Improvement; 2013.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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