12 Trials, 578 Patients, Zero Clear Answers: The Whooping Cough Treatment Dilemma

by Mandy Morgan April 15, 2025

If you’ve ever heard a child gasping between violent coughs—struggling for breath—you’ve witnessed just how brutal whooping cough can be. It’s not your average cold. And here’s the kicker: despite decades of research, we still don’t know how to make it better.

A recent Cochrane review combed through every serious study on symptomatic treatment for whooping cough (also called pertussis). The result? After analyzing 12 trials across 578 patients, researchers found… almost nothing that works.

So what’s going on here?

What Is Whooping Cough—and Why Does It Stick Around?

Whooping cough is caused by Bordetella pertussis, a nasty little bacterium that attacks the respiratory system. It’s especially dangerous in infants, but it’s no picnic for adults either. Despite vaccines, the disease has been making a comeback, partly because immunity fades and older kids or adults may unknowingly spread it.

Symptoms start mild, like a cold, but soon escalate to relentless coughing fits—or “paroxysms.” These spasms can trigger vomiting, exhaustion, and even cracked ribs in adults. In babies, they can be deadly.

So naturally, scientists and doctors have been searching for ways to relieve that trademark cough. They’ve tried antihistamines. Steroids. Salbutamol. Even pertussis-specific immunoglobulin. But do any of them work?

The Clinical Trials Say… Not Really

Let’s break it down.

🧪 What They Studied:

• 12 randomized or quasi-randomized trials
• 578 participants, mostly children
• Tested drugs like diphenhydramine (Benadryl), salbutamol (used in asthma), steroids, and pertussis immunoglobulin (antibodies)

🎯 What They Measured:

• Number of coughing fits
• Hospital stay duration
• Side effects
• Serious outcomes like vomiting, cyanosis (turning blue), and death

📉 What They Found:

• No treatment clearly reduced coughing. Not even close.
• One trial showed a possible reduction of 3 “whoops” a day with pertussis immunoglobulin—but the confidence interval still included zero.
• Side effects? Pretty mild. Think rash or loose stools.
• Hospital stays? No change across treatments.

Translation: These meds didn’t really move the needle. Not enough to justify widespread use.

Why This Matters: A Crisis of Evidence

The main issue isn’t that nothing works—it’s that we don’t actually know what works.

Most studies were:

• Small (some had fewer than 10 participants)
• Old (several from the 1970s or earlier)
• Inconsistent (using different ways to count coughs, report outcomes, or even define a “day”)

Only three trials were judged high quality. And even those didn’t find significant results.

So here we are in 2025, still trying to calm a 100-day cough with guesswork.

A Public Health Blind Spot

The review highlights a bigger issue in medicine: we assume we know how to treat symptoms—but often, we don’t.

Whooping cough isn’t just a childhood disease. It affects teens, adults, and yes—vaccinated people too. And when they get sick, there’s a risk of spreading it to vulnerable infants. If we can’t relieve symptoms effectively, we risk longer illness, more transmission, and greater strain on caregivers and health systems.

So What Now?

This isn’t a “nothing works, give up” story. It’s a call for better science.

The review ends with a clear plea: we need well-designed, modern trials that use consistent methods and look beyond old standbys. There’s room for new therapies, especially ones that target the inflammation and immune response unique to pertussis.

Until then? Doctors and families are stuck with supportive care—hydration, monitoring, and a whole lot of patience.

Join the Conversation

What do you think?

• Have you—or your child—ever dealt with whooping cough?
• Do you think we rely too much on symptom treatments that aren’t backed by evidence?
• What would you want to see in a new trial for treating whooping cough?

👇 Share your thoughts in the comments or tag us on social media.

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