The No. 1 cause for visits to the doctor's office in America is the common cough.

Although some coughs are associated with serious conditions such as tuberculosis or pneumonia, the vast majority are due to upper respiratory infections.

The common cold costs the U.S. economy $40 billion a year, according to a study by the University of Michigan Health System published in the Archives of Internal Medicine. Researchers found that colds result in nearly 400 million missed work and school days a year, too.

This significantly outpaces other conditions such as heart failure, emphysema and asthma.

It's no wonder that the cold and cough relief industry is a billion-dollar business. But a new study finds that Americans may not be getting their money's worth.

Cold Reality: Cough Meds May Not Work

The study, conducted by Ian Paul, M.D., and his colleagues at The Pennsylvania State University College of Medicine, examined whether two of the most common ingredients in cough medicines - dextromethorphan and diphenhydramine - actually relieve nighttime cough and sleep quality in children with upper respiratory infections.

They selected 100 children with symptomatic upper respiratory infections and randomly assigned them to one of three groups.

One group received dextromethorphan, a common cough suppressant. Another group received diphenhydramine, a decongestant and sleep aid. The final group received a placebo syrup containing no active ingredients.

Neither the physician nor the parent nor the patient knew which of the three the children were actually taking. The day after taking the medications, the parents were asked what, if any, effect the medication had. The results were surprising.

"All three groups, including the nonmedicated syrup group, showed dramatic improvement, with scores for cough frequency, impact on child and parent sleep, bothersome nature of cough, and severity of cough scoring lower," said Paul in a statement. "Neither dextromethorphan nor diphenhydramine was superior to placebo for any outcomes studied in this trial."

In fact, those receiving the placebo actually experienced a slight improvement in cough frequency.

"There was a significant improvement of all symptoms over the previous night, which should reassure clinicians and parents that, regardless of treatment, the natural history of an upper respiratory infection favors resolution of symptoms with time," Paul said.

"The desire to ease symptoms is strong for both parents and clinicians. This study, however, questions whether over-the-counter medications have a place in the treatment of these illnesses for children."

Cough medicine: A sham?

This is not the first time that over-the-counter (OTC) cough medications have come under fire. Just this month, the American College of Chest Physicians published new guidelines on the use of OTC medications for both adults and children.

"There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough," said Richard S. Irwin, M.D., of the University of Massachusetts Medical School in a statement concerning the guidelines.

"There is considerable evidence that older type antihistamines help to reduce cough, so, unless there are contraindications to using these medicines, why not take something that has been proven to work?"

"Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful," added Irwin, regarding the use of OTC medications in children. "In most cases, a cough that is unrelated to chronic lung conditions, environmental influences or other specific factors will resolve on its own."

Pharmacists, Dentists Speak Out

Pharmacists who routinely dispense these medications are also weighing in on the topic. "Other clinical trials have shown few benefits of using OTC cough medications," said Maria Bain, Pharm.D., M.B.A., and co-chair of the Medications Channel for Revolution Health Group's Medical Advisory Board.

"Coughs associated with colds or other viral infections usually do not respond to treatment with dextromethorphan or even codeine. The effectiveness of guaifenesin in treatment of cough in adults is also questionable," she said.

"Physicians and pharmacists should educate their patients that common OTC cough medications may not work, and taking more medication won't do the trick either. In fact, overdosing with OTC cough medications can be dangerous," Bain said.

Even the Academy of General Dentistry (AGD) is speaking out against the use of OTC cough syrups.

In the January/February issue of the journal General Dentistry, concern is expressed over the cavity-causing potential of sweetened cough syrups. The acids in the cough syrup, combined with the sugar, dissolve tooth enamel, causing erosion, the article said.

"It's important to talk with your dentist about any medications that your child is on and see what he or she recommends to combat the problems those medications might cause," said AGD spokesperson Paul Bussman, D.M.D., in a statement.

While more research is needed, Penn State's Paul suggested that clinicians consider the findings in these recent studies before formulating a treatment plan with patients.

He noted that not only are there potential adverse effects from using OTC medicines, but there are also cumulative financial costs. Dextromethorphan is fast becoming a drug of abuse among adolescents, he added.

So, what to do? Listen To Mom?

Doctors are advising people to use old-fashioned remedies like resting, drinking plenty of fluids, and taking something for pain, like Tylenol. And, they say people should treat the cause of the cough.

Most coughs usually come from post-nasal drip," according to the American College of Chest Physicians.

Chest doctors recommend antihistamines, like Benadryl, and decongestants, which dry up the sinuses and help you breathe.

Related links

OTC meds overused for children's colds

FDA warning on abuse of DXM

This Article is from MyDNA.com

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