Cough Syrups 'A Waste Of Money'

Cough Syrups 'A Waste Of Money'
By Andre Picard
The Globe and Mail
7-7-4

A glass of water will do as much to relieve your child's cough as an expensive, over-the-counter cough syrup, a new study suggests.The research, published in today's edition of the medical journal Pediatrics, concludes that parents who treat a child's nighttime cough with the widely available medications are wasting their money.

"Consumers spend billions of dollars each year on over-the-counter medications for cough," said Ian Paul, an assistant professor of pediatrics at Penn State Children's Hospital in Hershey, Pa.

"But our study showed that the two ingredients used in most over-the-counter medications were no better than a placebo, non-medicated syrup, in providing nighttime relief for children with cough and sleep difficulty as a result of upper-respiratory infection," he said.

In Canada, cough syrup sales exceed $80-million a year, according to the Non-Prescription Drug Manufacturers Association.

About 95 per cent of syrups, including the best-selling brands Benylin DM and Robitussin, have dextromethorphan as their active ingredient. It is an expectorant, meaning it is supposed to clear the respiratory tract of phlegm and make breathing easier. Other cough syrups contain diphenhydramine, an antihistamine, designed to reduce swelling in the respiratory tract.

To conduct the study, researchers recruited 100 children with upper-respiratory-tract infections who had been coughing for an average of more than three days.

The children were given one of three treatments 30 minutes before bedtime: A cough syrup containing dextromethorphan, a cough syrup containing diphenhydramine or a placebo syrup.

Children in all three groups showed a dramatic reduction in cough frequency, but those taking the placebo -- essentially flavoured water -- had the best results. On four other measures, the three treatments had virtually identical outcomes.

Dr. Paul said this demonstrates that time and proper hydration are the best treatment for most respiratory infections and that the benefit that comes from cough syrups is likely psychological.

"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."

The study confirms what many physicians already know. In fact, the Merck Manual of Diagnosis and Therapy, a reference book used by physicians and written by an editorial board of medical experts, says there is little evidence that cough syrups provide any benefit.

George Murray, co-owner of the Tantramar Pharmacy in Sackville, N.B., said the new research is nonetheless useful because it will get consumers thinking a little before reaching for medication.

"In my opinion, anything that pushes people to dialogue with their pharmacist and make more informed choices is beneficial."

Mr. Murray said he generally tells people with respiratory infections that fluid and rest are the best treatments, but he recognizes that some seek the reassurance of taking an over-the-counter medication.

"If there's a placebo effect that works, why not?" he said.

While they may not provide much benefit, the cough syrups have virtually no side effects if taken at the recommended doses.

However, dextromethorphan, or DXM as it is known on the streets, has become a popular recreational drug. Taken in significant doses -- and up to 1,500 milligrams is not uncommon -- it is a psychedelic, one that has found favour with computer fantasy game players.

Dr. Paul said while this was not a focus of his research, the abuse of cough syrup by teenagers is another reason to not have the product around the house.

Most pediatricians recommend that if a cough syrup is used, that parents buy the smallest bottle and toss it out when the respiratory-tract infection has passed.

Adult formulations of cough syrup are similar, but contain higher doses of the active ingredients.

© Copyright 2004 Bell Globemedia Publishing Inc. All Rights Reserved. http://www.theglobeandmail.com/servlet/story/RTGAM.2
0040706.wxhcough06/BNStory/specialScienceandHealth/
Tweet