Smoker’s cough in adolescents: pathogenesis, clinical features and use of butamirate

This review was aimed to the systematization of modern data on the prevalence of smoking among adolescents, the pathogenesis of «smoker’s cough» in minors and the possibilities of symptomatic therapy with butamirate. The analysis of publications from international databases (Medline/PubMed, Scopus, eLIBRARY) for 2000–2025, normative and methodological documents of WHO, the European Respiratory Society and the National Institute for Clinical Excellence (NICE) was conducted. It was shown that active or passive consumption of nicotine-containing products is observed in 8–12% of Russian schoolchildren aged 15–17, and the incidence of chronic productive cough in young smokers is 2–3 times higher than in non-smoking peers. The key pathogenetic mechanisms of cough formation include activation of TRPV1/TRPA1 sensitive afferent fibers, neutrophil-mediated inflammation, impaired mucociliary clearance and puberty-dependent increase in the sensitivity of the cough reflex (more pronounced in girls). Butamirate exhibits a dose-dependent central antitussive effect, moderate bronchodilator and anti-inflammatory potential; the cumulative reduction in the frequency of cough shocks in the child and adolescent population reaches 40–60% within the first week of treatment, and the frequency of adverse reactions does not exceed 2%. Based on a comparison with alternative agents (dextromethorphan, levodropropizine, inhaled GCS), an algorithm for managing adolescents with chronic «smoker’s cough», including the stages of screening for tobacco smoking, basic differential diagnostics of the causes of chronic cough and a short-term course of butamirate (7–14 days) with subsequent evaluation of effectiveness is proposed.