TUESDAY, Jan. 10, 2006 (HealthDay News) -- There's no scientific evidence to suggest that the over-the-counter cough medicines that line pharmacy shelves really work, a leading physicians' group has concluded.
"The bottom line is, when you look at the well-done scientific studies, there were very few showing that any of the cough and cold products that we often buy are in fact effective for the acute cough from the common cold," said Dr. Peter Dicpinigaitis, director of the Montefiore Cough Center in New York City. "We're not saying there's no role for any of these products but, for the common cold, there are very few good studies showing that any of these drugs do work."
The finding was part of new guidelines released Monday by the American College of Chest Physicians (ACCP). Dicpinigaitis, who's also director of the intensive care unit at Montefiore Medical Center in New York City, was one of the authors of the guidelines.
Dr. Richard Irwin, professor of medicine at the University of Massachusetts Medical School and chairman of the American College of Chest Physicians' cough guidelines committee said the new guidelines don't mean that "all over-the-counter cough products are bad," he said. "It's just that most of them don't work."
Called Diagnosis and Management of Cough: Evidence-Based Clinical Practice Guidelines, the guidelines contain more than 200 recommendations for diagnosing and managing acute and chronic cough. They have been endorsed by the American Thoracic Society and the Canadian Thoracic Society, and will be published as a supplement to the January issue of CHEST, the journal of the ACCP.
The Consumer Healthcare Products Association, which represents manufacturers and distributors of over-the-counter products, disagreed with the cough medicine guidelines.
"Over-the-counter, or OTC, cough/cold products provide relief to millions of consumers each year," the organization said in a statement. "The United States Food and Drug Administration (FDA) and other regulatory agencies world-wide support the use of over-the-counter cough/cold products for providing relief of coughs and other symptoms associated with the common cold, and studies support symptom relief among consumers using these products."
According to the ACCP, 29.5 million of the estimated 829 million annual visits to office-based physicians in the United States are for cough.
"Cough is the single most common reason that patients in the U.S. go to their doctor," said Dicpinigaitis. "Since it's a problem that's so huge, we certainly felt that well-written, state-of-the-art guidelines were necessary to help physicians all over the country deal with this common and often very difficult problem."
And the cough that comes with the common cold tends to be "particularly stubborn," Dicpinigaitis said.
So is there a remedy for constant, painful hacking, other than chicken soup?
One is time, which eventually heals all wounds, even the common cough, according to the ACCP.
Products containing older-generation antihistamines such as diphenhydramine (found in Benadryl), with or without a decongestant, may be of benefit, Dicpinigaitis said.
"In terms of rigorous studies, the one class that has been shown to have some benefit are the older generation antihistamines combined with decongestant," Dicpinigaitis said. "They're available over-the-counter and by prescription depending on the strength."
These are the same substances that have been taken out of newer products because they can cause drowsiness, the Associated Press reported. Many products containing these antihistamines are not marketed specifically for colds, the news service said.
Codeine and dextromethorphan, found in some over-the-counter cough formulations, may be effective but are usually found in doses too small to be helpful, the ACCP said.
There is another concern about using ineffectual treatments: They may cause the patient to delay seeking help for serious conditions such as whooping cough, doctors said.
"If a patient doesn't have any nose symptoms and he or she is coughing, then you should not be thinking they have the common cold," Irwin stated. The cough should also be gone within three weeks, he said.
The guidelines also recommend that adults up to the age of 65 receive the new adult vaccine for whooping cough (pertussis). Although most Americans were vaccinated against the disease as children, the vaccine is only effective for about 10 years. Today, more than a quarter of cases of whooping cough in the United States occur in adults.
Finally, the new guidelines state that children aged 14 and younger should not use adult over-the-counter cough and cold preparations.
"It's no mystery to doctors that the over-the-counter preparations may not do much for the cough but the guidelines are stating the fact that there are very few well-done scientific studies to support their use," Dicpinigaitis said. "That's not to say that some of these products may not be helpful for some people to some degree, but those studies just aren't out there."
More information
The U.S. National Library of Medicine has more about cough.
