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New Guidelines Challenge OTC Cough Syrup Use

Breaking News - January 2006 - Week 2

(Jan 11, 2006)

Healthcare in  the News

-- Most over-the-counter (OTC) cough syrups do not work, according to new guidelines published in the medical journal Chest.

A picture of a female healthcare worker with a female patient

The guidelines from the American College of Chest Physicians (ACCP) include more than 200 recommendations for diagnosing and managing different kinds of coughs.

The guidelines emphasize that OTC expectorants or suppressants (such as cough syrups and cough drops) do not treat the underlying causes of a cough.

The guidelines were developed by an international committee of individuals with expertise and research experience related to cough from the fields of adult and pediatric pulmonology and respirology, pharmacology, neurology, speech and swallowing, and anatomy and physiology.

The American Thoracic Society and the Canadian Thoracic Society also endorse the new guidelines.

“Cough is the number one reason why patients seek medical attention. Although an occasional cough is normal, excessive coughing or coughing that produces blood, or thick, discolored mucus is abnormal,” says Dr. Richard S. Irwin, of the University of Massachusetts Medical School in Worcester, Mass., who served as Chair of the guidelines committee.

Cough Management Defined

“The new ACCP guidelines define how physicians should diagnose and manage cough associated with everything from the common cold to chronic lung conditions," states Dr. Irwin.

Of the estimated 829 million visits to office-based physicians in the US, approximately 29.5 million are for cough.

An acute cough is generally caused by a “common cold;” a subacute cough can linger after a cold or may persist due to a respiratory tract infection, such as whooping cough or other postinfectious cough (a cough that lingers for several days or longer after an acute infection such as the flu).

Additional recommendations address the most common causes of chronic cough, including upper airway cough syndrome (previously named postnasal drip syndrome), asthma, and gastroesophageal reflux disease (GERD).

Chronic cough also may be a result of smoking or taking angiotensin-converting enzyme (ACE) inhibitors (a type of medication used to treat heart conditions such as heart failure).

“Chronic cough can significantly compromise quality of life for patients. However, patients with chronic cough do not have to continue suffering from their condition,” says Dr. W. Michael Alberts, president of the American College of Chest Physicians.

“The new ACCP guidelines provide clinicians with proven methods of identifying and treating the underlying causes of chronic cough, ultimately, leading to more effective management of chronic cough and better quality of life for patients,” Dr. Alberts states.

Older Medications Are Better

The guidelines recommend that adults with acute cough or postnasal drip use an older variety of antihistamine with a decongestant.

“There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough,” says Dr. Irwin.

“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?” Dr. Irwin adds.

Recommendations for Kids

The ACCP guidelines are the first to provide comprehensive, specific, evidence-based recommendations for the diagnosis and management of cough in children.

Although the guidelines address all types of pediatric cough, they make a strong recommendation against the use of OTC cough and cold medications for children age 14 years and younger.

According to Dr. Irwin, "Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful."

"In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own," Dr. Irwin says.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

Sugary Medications May Lead to Cavities

A spoon full of sugar may help the medicine go down, but most dentists would likely encourage parents to skip that step when treating a child’s illness, according to the Academy of General Dentistry (AGD).

However, most parents might not realize that even without the sugar, some children’s medicines may cause cavities while they are fighting other health issues, according to a report in the journal General Dentistry.

Antihistamine syrups are frequently purchased over-the-counter or prescribed to deal with problems such as chronic allergies or the flu.

However, many of these syrups are highly acidic, which can be dangerous for a child’s teeth.

The sugar in the medication combined with the acids dissolve dental enamel, causing erosion.

“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,” says AGD spokesperson Dr. Paul Bussman.

The report revealed that placing children’s teeth in contact with syrupy medications could cause erosion to the outer layers of the teeth.

However, when teeth were treated with a topical fluoride treatment, the decay was minimal.

“Although some medications are necessary for general health they can be extremely harmful to the teeth if the medicine is given at bedtime or without following proper oral health habits,” says Dr. Carolina Covolo da Costa, author of the study.

Since the flow of saliva, nature’s buffer against cavities, decreases during the night, medicines given before bedtime can do a great deal of damage if a child does not brush away sugar and acids.

A fluoride toothpaste can provide extra protection against decay. If brushing is not possible, rinsing the mouth with water can minimize the risk.

Tips for taking medicine:

  • Take the medication at meal times instead of bedtime.
  • Rinse with water or chew sugar-free gum afterwards if brushing is not an option.
  • Check with your pediatrician or dentist about taking calcium supplements or using a topical fluoride.

Always consult your child's physician or dentist for a diagnosis.

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