The Experts below are selected from a list of 6267 Experts worldwide ranked by ideXlab platform
Ellen R Wald - One of the best experts on this subject based on the ideXlab platform.
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Decongestants antihistamines and nasal irrigation for acute sinusitis in children
Cochrane Database of Systematic Reviews, 2014Co-Authors: Nader Shaikh, Ellen R WaldAbstract:Background The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Objectives To determine the efficacy of Decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors' conclusions There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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Decongestants, antihistamines and nasal irrigation for acute sinusitis in children.
The Cochrane database of systematic reviews, 2012Co-Authors: Nader Shaikh, Ellen R WaldAbstract:The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. To systematically review the efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis. We considered the following four interventions: 1) Decongestants versus placebo or no medication, 2) antihistamines versus placebo or no medication, 3) decongestant and antihistamine combination versus placebo or no medication, 4) nasal irrigation versus no irrigation. The primary outcomes of the review were symptom resolution (improvement in symptom score from enrolment to day five and overall symptom burden (as measured by average symptom scores while on therapy). We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 1), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to January week 3, 2012) and EMBASE (1950 to January 2012). We included randomized controlled trials (RCTs) and quasi-RCTs which evaluated children less than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Two review authors independently assessed each study for inclusion. Of the 526 studies found through the electronic searches and handsearching, none met all the inclusion criteria. There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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The Cochrane Library - Decongestants, antihistamines and nasal irrigation for acute sinusitis in children.
Cochrane Database of Systematic Reviews, 2012Co-Authors: Nader Shaikh, Ellen R WaldAbstract:Background The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Objectives To determine the efficacy of Decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors' conclusions There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
Nader Shaikh - One of the best experts on this subject based on the ideXlab platform.
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Decongestants antihistamines and nasal irrigation for acute sinusitis in children
Cochrane Database of Systematic Reviews, 2014Co-Authors: Nader Shaikh, Ellen R WaldAbstract:Background The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Objectives To determine the efficacy of Decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors' conclusions There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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Decongestants, antihistamines and nasal irrigation for acute sinusitis in children.
The Cochrane database of systematic reviews, 2012Co-Authors: Nader Shaikh, Ellen R WaldAbstract:The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. To systematically review the efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis. We considered the following four interventions: 1) Decongestants versus placebo or no medication, 2) antihistamines versus placebo or no medication, 3) decongestant and antihistamine combination versus placebo or no medication, 4) nasal irrigation versus no irrigation. The primary outcomes of the review were symptom resolution (improvement in symptom score from enrolment to day five and overall symptom burden (as measured by average symptom scores while on therapy). We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2012, Issue 1), which includes the Acute Respiratory Infections Group's Specialized Register, MEDLINE (1950 to January week 3, 2012) and EMBASE (1950 to January 2012). We included randomized controlled trials (RCTs) and quasi-RCTs which evaluated children less than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Two review authors independently assessed each study for inclusion. Of the 526 studies found through the electronic searches and handsearching, none met all the inclusion criteria. There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
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The Cochrane Library - Decongestants, antihistamines and nasal irrigation for acute sinusitis in children.
Cochrane Database of Systematic Reviews, 2012Co-Authors: Nader Shaikh, Ellen R WaldAbstract:Background The efficacy of Decongestants, antihistamines and nasal irrigation in children with clinically diagnosed acute sinusitis has not been systematically evaluated. Objectives To determine the efficacy of Decongestants, antihistamines or nasal irrigation in improving symptoms of acute sinusitis in children. Search methods We searched CENTRAL (2014, Issue 5), MEDLINE (1950 to June week 1, 2014) and EMBASE (1950 to June 2014). Selection criteria We included randomized controlled trials (RCTs) and quasi-RCTs, which evaluated children younger than 18 years of age with acute sinusitis, defined as 10 to 30 days of rhinorrhea, congestion or daytime cough. We excluded trials of children with chronic sinusitis and allergic rhinitis. Data collection and analysis Two review authors independently assessed each study for inclusion. Main results Of the 662 studies identified through the electronic searches and handsearching, none met all the inclusion criteria. Authors' conclusions There is no evidence to determine whether the use of antihistamines, Decongestants or nasal irrigation is efficacious in children with acute sinusitis. Further research is needed to determine whether these interventions are beneficial in the treatment of children with acute sinusitis.
D Taverner - One of the best experts on this subject based on the ideXlab platform.
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WITHDRAWN: Nasal Decongestants for the common cold.
Cochrane Database of Systematic Reviews, 2009Co-Authors: D Taverner, G. Jenny LatteAbstract:Background The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. Objectives To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. Search strategy In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Selection criteria Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Data collection and analysis Two review authors (DT, GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Main results Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. Authors' conclusions A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
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nasal Decongestants for the common cold
Cochrane Database of Systematic Reviews, 2009Co-Authors: D Taverner, J LatteAbstract:Background The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. Objectives To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. Search strategy In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Selection criteria Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Data collection and analysis Two review authors (DT, GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Main results Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. Authors' conclusions A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
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Nasal Decongestants for the common cold.
The Cochrane database of systematic reviews, 2007Co-Authors: D Taverner, J LatteAbstract:The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2006); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Two review authors (DT and GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
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The Cochrane Library - Nasal Decongestants for the common cold.
Cochrane Database of Systematic Reviews, 2004Co-Authors: D Taverner, G. Jenny LatteAbstract:Background The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. Objectives To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. Search strategy In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Selection criteria Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Data collection and analysis Two review authors (DT, GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Main results Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. Authors' conclusions A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
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Nasal Decongestants for the common cold.
The Cochrane database of systematic reviews, 2000Co-Authors: D Taverner, L Bickford, M DraperAbstract:The common cold is a major and recurrent cause of morbidity, affecting children and adults two or more times each year. Nasal congestion is its commonest symptom, and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants for the common cold. To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. MEDLINE, EMBASE and Current Contents were searched up to May 1999. Searching the Cochrane Acute Respiratory Infections Group's trials register, following the review citation trail from other references and contacting known principal investigators and pharmaceutical companies was also done. Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from the common cold. Data were independently extracted by two reviewers (DT and LB). All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Four studies in adults, but none in children, fitted all inclusion criteria. There was a significant 13% decrease in subjective symptoms after decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. Repeated doses of nasal decongestant were not significantly better than placebo at relieving symptoms of nasal congestion. A single dose of nasal decongestant in the common cold is moderately effective for the short term relief of congestion in adults, while there is no evidence available to show benefit after repeated use over several days. These medications are not recommended for use in young children with the common cold.
J Latte - One of the best experts on this subject based on the ideXlab platform.
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nasal Decongestants for the common cold
Cochrane Database of Systematic Reviews, 2009Co-Authors: D Taverner, J LatteAbstract:Background The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. Objectives To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. Search strategy In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2006, issue 3); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Selection criteria Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Data collection and analysis Two review authors (DT, GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Main results Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. Authors' conclusions A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
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Nasal Decongestants for the common cold.
The Cochrane database of systematic reviews, 2007Co-Authors: D Taverner, J LatteAbstract:The common cold is a major and recurrent cause of morbidity, on average affecting children and adults two or more times each year. Nasal congestion is its commonest symptom and many therapies are marketed for its relief. There is no meta-analysis of controlled clinical trials on the effects of nasal Decongestants in the common cold. To assess the efficacy of nasal Decongestants at reducing the symptom of nasal congestion in adults and children with the common cold and to identify possible adverse effects associated with their use. In this updated review in 2006, the following databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2006); MEDLINE (January 1996 to September 2006); OLDMEDLINE (1951 to 1965); EMBASE (1980 to Week 36, 2006). We contacted known principal investigators and pharmaceutical companies. Randomised, placebo controlled trials of single-active oral and topical nasal Decongestants in adults and children suffering from common cold. Two review authors (DT and GJL) independently extracted data. All outcomes variables were continuous. Subjective outcomes were normalised to a common scale and a weighted mean difference (WMD) was calculated. A standardised mean difference (SMD) was calculated for the objective outcomes. Seven studies in adults, but none in children, fitted all inclusion criteria. There was a small but statistically significant 6% decrease in subjective symptoms after a single dose of decongestant compared with placebo. This was supported by a significant decrease in nasal airways resistance. With repeated doses, nasal Decongestants produce a very small statistical benefit of 4% over three to five days, again supported by a decrease in nasal airways resistance. Two studies provided safety data for this meta-analysis, showing a relatively small number of adverse events and only a small increased risk of insomnia with pseudoephedrine compared to placebo. A single oral dose of nasal decongestant in the common cold is modestly effective for the short term relief of congestion in adults, and these drugs also provide benefit in some individuals after regular use over three to five days. Adverse events in adults are rare and mild. There is insufficient data on the use of these medications in children and therefore they are not recommended for use in children younger than 12 years of age with the common cold.
Mieke L Van Driel - One of the best experts on this subject based on the ideXlab platform.
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Nasal Decongestants in monotherapy for the common cold (Review)
Cochrane Database of Systematic Reviews, 2016Co-Authors: Laura Deckx, An De Sutter, Linda Guo, Nabiel A Mir, Mieke L Van DrielAbstract:Background: Many treatments for the common cold exist and are sold over-the-counter. Nevertheless, evidence on the effectiveness and safety of nasal Decongestants is limited. Objectives: To assess the efficacy, and short- and long-term safety, of nasal Decongestants used in monotherapy to alleviate symptoms of the common cold in adults and children. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6, June 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Specialised Register, MEDLINE (1946 to July 2016), Embase (2010 to 15 July 2016), CINAHL (1981 to 15 July 2016), LILACS (1982 to July 2016), Web of Science (1955 to July 2016) and clinical trials registers. Selection criteria: Randomised controlled trials (RCTs) and cluster-RCTs investigating the effectiveness and adverse effects of nasal Decongestants compared with placebo for treating the common cold in adults and children. We excluded quasi-RCTs. Data collection and analysis: Three review authors independently extracted and summarised data on subjective measures of nasal congestion, overall patient well-being score, objective measures of nasal airway resistance, adverse effects and general recovery. One review author acted as arbiter in cases of disagreement. We categorised trials as single and multi-dose and analysed data both separately and together. We also analysed studies using an oral or topical nasal decongestant separately and together. Main results: We included 15 trials with 1838 participants. Fourteen studies included adult participants only (aged 18 years and over). In six studies the intervention was a single dose and in nine studies multiple doses were used. Nine studies used pseudoephedrine and three studies used oxymetazoline. Other Decongestants included phenylpropanolamine, norephedrine and xylometazoline. Phenylpropanolamine (or norephedrine) is no longer available on the market therefore we did not include the results of these studies in the meta-analyses. Eleven studies used oral Decongestants; four studies used topical Decongestants. Participants were included after contracting the common cold. The duration of symptoms differed among studies; in 10 studies participants had symptoms for less than three days, in three studies symptoms were present for less than five days, one study counted the number of colds over one year, and one study experimentally induced the common cold. In the single-dose studies, the effectiveness of a nasal decongestant was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days. Most studies were conducted in university settings (N = eight), six at a specific university common cold centre. Three studies were conducted at a university in collaboration with a hospital and two in a hospital only setting. In two studies the setting was unclear. There were large differences in the reporting of outcomes and the reporting of methods in most studies was limited. Therefore, we judged most studies to be at low or unclear risk of bias. Pooling was possible for a limited number of studies only; measures of effect are expressed as standardised mean differences (SMDs). A positive SMD represents an improvement in congestion. There is no defined minimal clinically important difference for measures of subjective improvement in nasal congestion, therefore we used the SMDs as a guide to assess whether an effect was small (0.2 to 0.49), moderate (0.5 to 0.79) or large (≥ 0.8). Single-dose decongestant versus placebo: 10 studies compared a single dose of nasal decongestant with placebo and their effectiveness was tested between 15 minutes and 10 hours after dosing. Seven of 10 studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion. Two studies recorded adverse events. Both studies used an oral decongestant and each of them showed that there was no statistical difference between the number of adverse events in the treatment group versus the placebo group. Multi-dose decongestant versus placebo: nine studies compared multiple doses of nasal Decongestants with placebo, but only five reported on the primary outcome, subjective symptom scores for nasal congestion. Only one study used a topical decongestant; none reported overall patient well-being. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately three hours after the last dose (SMD 0.49, 95% confidence interval (CI) 0.07 to 0.92; P = 0.02; GRADE: low-quality evidence). However, the SMD of 0.49 only indicates a small clinical effect. Pooling was based on two studies, one oral and one topical, therefore we were unable to assess the effects of oral and topical Decongestants separately. Seven studies reported adverse events (six oral and one topical decongestant); meta-analysis showed that there was no statistical difference between the number of adverse events in the treatment group (125 per 1000) compared to the placebo group (126 per 1000). The odds ratio (OR) for adverse events in the treatment group was 0.98 (95% CI 0.68 to 1.40; P = 0.90; GRADE: low-quality evidence). The results remained the same when we only considered studies using an oral decongestant (OR 0.95, 95% CI 0.65 to 1.39; P = 0.80; GRADE: low-quality evidence). Authors' conclusions: We were unable to draw conclusions on the effectiveness of single-dose nasal Decongestants due to the limited evidence available. For multiple doses of nasal Decongestants, the current evidence suggests that these may have a small positive effect on subjective measures of nasal congestion in adults with the common cold. However, the clinical relevance of this small effect is unknown and there is insufficient good-quality evidence to draw any firm conclusions. Due to the small number of studies that used a topical nasal decongestant, we were also unable to draw conclusions on the effectiveness of oral versus topical Decongestants. Nasal Decongestants do not seem to increase the risk of adverse events in adults in the short term. The effectiveness and safety of nasal Decongestants in children and the clinical relevance of their small effect in adults is yet to be determined.
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nasal Decongestants in monotherapy for the common cold
Cochrane Database of Systematic Reviews, 2016Co-Authors: Laura Deckx, An De Sutter, Linda Guo, Nabiel A Mir, Mieke L Van DrielAbstract:Background Many treatments for the common cold exist and are sold over-the-counter. Nevertheless, evidence on the effectiveness and safety of nasal Decongestants is limited. Objectives To assess the efficacy, and short- and long-term safety, of nasal Decongestants used in monotherapy to alleviate symptoms of the common cold in adults and children. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6, June 2016), which contains the Cochrane Acute Respiratory Infections (ARI) Specialised Register, MEDLINE (1946 to July 2016), Embase (2010 to 15 July 2016), CINAHL (1981 to 15 July 2016), LILACS (1982 to July 2016), Web of Science (1955 to July 2016) and clinical trials registers. Selection criteria Randomised controlled trials (RCTs) and cluster-RCTs investigating the effectiveness and adverse effects of nasal Decongestants compared with placebo for treating the common cold in adults and children. We excluded quasi-RCTs. Data collection and analysis Three review authors independently extracted and summarised data on subjective measures of nasal congestion, overall patient well-being score, objective measures of nasal airway resistance, adverse effects and general recovery. One review author acted as arbiter in cases of disagreement. We categorised trials as single and multi-dose and analysed data both separately and together. We also analysed studies using an oral or topical nasal decongestant separately and together. Main results We included 15 trials with 1838 participants. Fourteen studies included adult participants only (aged 18 years and over). In six studies the intervention was a single dose and in nine studies multiple doses were used. Nine studies used pseudoephedrine and three studies used oxymetazoline. Other Decongestants included phenylpropanolamine, norephedrine and xylometazoline. Phenylpropanolamine (or norephedrine) is no longer available on the market therefore we did not include the results of these studies in the meta-analyses. Eleven studies used oral Decongestants; four studies used topical Decongestants. Participants were included after contracting the common cold. The duration of symptoms differed among studies; in 10 studies participants had symptoms for less than three days, in three studies symptoms were present for less than five days, one study counted the number of colds over one year, and one study experimentally induced the common cold. In the single-dose studies, the effectiveness of a nasal decongestant was measured on the same day, whereas the follow-up in multi-dose studies ranged between one and 10 days. Most studies were conducted in university settings (N = eight), six at a specific university common cold centre. Three studies were conducted at a university in collaboration with a hospital and two in a hospital only setting. In two studies the setting was unclear. There were large differences in the reporting of outcomes and the reporting of methods in most studies was limited. Therefore, we judged most studies to be at low or unclear risk of bias. Pooling was possible for a limited number of studies only; measures of effect are expressed as standardised mean differences (SMDs). A positive SMD represents an improvement in congestion. There is no defined minimal clinically important difference for measures of subjective improvement in nasal congestion, therefore we used the SMDs as a guide to assess whether an effect was small (0.2 to 0.49), moderate (0.5 to 0.79) or large (≥ 0.8). Single-dose decongestant versus placebo: 10 studies compared a single dose of nasal decongestant with placebo and their effectiveness was tested between 15 minutes and 10 hours after dosing. Seven of 10 studies reported subjective symptom scores for nasal congestion; none reported overall patient well-being. However, pooling was not possible due to the large diversity in the measurement and reporting of symptoms of congestion. Two studies recorded adverse events. Both studies used an oral decongestant and each of them showed that there was no statistical difference between the number of adverse events in the treatment group versus the placebo group. Multi-dose decongestant versus placebo: nine studies compared multiple doses of nasal Decongestants with placebo, but only five reported on the primary outcome, subjective symptom scores for nasal congestion. Only one study used a topical decongestant; none reported overall patient well-being. Subjective measures of congestion were significantly better for the treatment group compared with placebo approximately three hours after the last dose (SMD 0.49, 95% confidence interval (CI) 0.07 to 0.92; P = 0.02; GRADE: low-quality evidence). However, the SMD of 0.49 only indicates a small clinical effect. Pooling was based on two studies, one oral and one topical, therefore we were unable to assess the effects of oral and topical Decongestants separately. Seven studies reported adverse events (six oral and one topical decongestant); meta-analysis showed that there was no statistical difference between the number of adverse events in the treatment group (125 per 1000) compared to the placebo group (126 per 1000). The odds ratio (OR) for adverse events in the treatment group was 0.98 (95% CI 0.68 to 1.40; P = 0.90; GRADE: low-quality evidence). The results remained the same when we only considered studies using an oral decongestant (OR 0.95, 95% CI 0.65 to 1.39; P = 0.80; GRADE: low-quality evidence). Authors' conclusions We were unable to draw conclusions on the effectiveness of single-dose nasal Decongestants due to the limited evidence available. For multiple doses of nasal Decongestants, the current evidence suggests that these may have a small positive effect on subjective measures of nasal congestion in adults with the common cold. However, the clinical relevance of this small effect is unknown and there is insufficient good-quality evidence to draw any firm conclusions. Due to the small number of studies that used a topical nasal decongestant, we were also unable to draw conclusions on the effectiveness of oral versus topical Decongestants. Nasal Decongestants do not seem to increase the risk of adverse events in adults in the short term. The effectiveness and safety of nasal Decongestants in children and the clinical relevance of their small effect in adults is yet to be determined.
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The Cochrane Library - Oral antihistamine-decongestant-analgesic combinations for the common cold.
Cochrane Database of Systematic Reviews, 2012Co-Authors: An De Sutter, Mieke L Van Driel, Anna A Kumar, Olivia Lesslar, Alja SkrtAbstract:Background Although combination formulas containing antihistamines, Decongestants and/or analgesics are sold over-the-counter (OTC) in large quantities for the common cold, the evidence of effectiveness is limited. Objectives To assess the effectiveness of antihistamine-decongestant-analgesic combinations in reducing the duration and alleviating the symptoms of the common cold in adults and children. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, OLDMEDLINE (1953 to 1965), MEDLINE (1966 to November Week 3, 2011) and EMBASE (1990 to December 2011). Selection criteria Randomised controlled trials (RCTs) investigating the effectiveness of antihistamine-decongestant-analgesic combinations compared with placebo, other active treatment (excluding antibiotics) or no treatment in children and adults with the common cold. Data collection and analysis Two review authors independently extracted and summarised data on general recovery, nasal obstruction, rhinorrhoea, sneezing, cough and side effects. We categorised the trials according to the active ingredients. Main results We included 27 trials (5117 participants) of common cold treatments. Fourteen trials studied antihistamine-decongestant combinations; two antihistamine-analgesic; six analgesic-decongestant; and five antihistamine-analgesic-decongestant combinations. In 21 trials the control intervention was placebo and in six trials an active substance. Reporting of methods in most trials was poor and there were large differences in design, participants, interventions and outcomes. Pooling was only possible for a limited number of studies and outcomes. Antihistamine-decongestant: 12 trials. Eight trials report on global effectiveness, six could be pooled; n = 309 on active treatment, n = 312 placebo) the odds ratio (OR) of treatment failure was 0.27 (95% confidence interval (CI) 0.15 to 0.50); the number needed to treat for an additional beneficial outcome (NNTB) was four (95% CI 3 to 5.6). On the final evaluation day 41% of participants in the placebo group had a favourable response compared to 66% on active treatment. Of the two trials that were not included in the pooling, one showed some global effect, the other showed no effect. Antihistamine-analgesic: three trials. Two reported on global effectiveness, data from one study was presented. (n = 290 on active treatment, n = 292 ascorbic acid). The OR of treatment failure was 0.33 (95% CI 0.23 to 0.46) and the NNTB was 6.67 (95% CI 4.76 to 12.5). After six days of treatment 43% were cured in the control group and 70% in the active treatment group. The second study also showed an effect in favour of active treatment. Analgesic-decongestant: six trials. One trial reported on global effectiveness: 73% benefited compared with 52% in the control group (paracetamol) (OR 0.28, 95% CI 0.15 to 0.52). Antihistamine-analgesic-decongestant: Five trials. Four trials reported on global effectiveness, two could be pooled: global effect reported (less than one severity point on a four or five-point scale) with active treatment (52%) and placebo (34%); the OR of treatment failure was 0.47 (95% CI 0.33 to 0.67) and the NNTB was 5.6 (95% CI 3.8 to 10.2). Two other trials found no beneficial effect. Two other studies did not show any effect. Two studies with antihistamine-decongestant (113 children) could not be pooled. There was no significant effect of the active treatment. Adverse effects: the combination of antihistamine-decongestant had more adverse effects than the control intervention but the difference was not significant: 157/810 (19%) versus 60/477 (13%) participants suffered one or more adverse effects (OR 1.58, 95% CI 0.78 to 3.21). Analgesic-decongestant combinations had significantly more adverse effects than control (OR 1.71, 95% CI 1.23 to 2.37); the number needed to treat for an additional harmful outcome (NNTH) was 14. None of the other two combinations caused significantly more adverse effects. Antihistamine-analgesic: 11/90 with combination suffered one or more adverse effects (12%) versus 9/91 (10%) with control (OR 1.27, 95% CI 0.50 to 3.23). Antihistamine-analgesic-decongestant: in one study 5/224 (2%) suffered adverse effects with active treatment versus 9/208 (4%) with placebo. Two other trials reported no differences between treatment groups but numbers were not reported. Authors' conclusions Current evidence suggests that antihistamine-analgesic-decongestant combinations have some general benefit in adults and older children. These benefits must be weighed against the risk of adverse effects. There is no evidence of effectiveness in young children.
