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A Second Look at Cough Syrup

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A Second Look at Cough Syrup

A Second Look at Cough Syrup

March 20, 2006
By: Jean Johnson for Body1

Good old Luden’s and other cough remedies under attack as nothing more than snake oil?

It would seem so, given the new guidelines by the American College of Chest Physicians (ACCP) published in the medical journal Chest.

In a listing of more than 200 recommendations for diagnosing and treating different coughs, the ACCP pointed a finger at cough syrups. Not only are these products ineffective according to the ACCP findings, the pharmacopoeia of sugar-laced potions, lozenges and sprays take a hard toll on the teeth. Sigh. What’s a mother to do?

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Protect Your Health and Your Teeth

The rule of thumb is to take nothing but water by mouth after teeth are carefully brushed and flossed prior to bedtime.

When considering sugar intake, include foods, drinks, and medicinal syrups. Brushing within a 20-minute window after consuming anything containing sugar helps protect teeth from decay. Fluoride treatments can also help children.

Consider hydration to help coughing. Drinking at least eight glasses of water or herbal tea daily will help break up congestion in the lungs and ease coughing related to colds and the flu.

The Sugar Issue

Concurrent to the Chest publication in early 2006 was a peer-reviewed clinical article in General Dentistry, the Academy of General Dentistry’s journal, in which a Brazilian scholar took on antihistamine syrups specifically. With their load of sugar, the syrups could create as many health problems as they solve, says the dental researcher.

“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, “said Dr. Caroline Covolo da Costa, author of the study and on the faculty at Federal University of Santa Catarina in Brazil.
The Academy of General Dentistry spokesman Paul Bussman, D.M.D., underscored Covolo da Costa’s conclusions.
“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,” Bussman said. “Parents need to be aware that long-term use of syrupy cough medications, especially at bedtime, could cause an increased risk of tooth decay," adding that taking this type of product is "very much similar to allowing a child to drink juice before bedtime." Bussman’s point is that considerably less saliva is produced at night during sleep, so it is especially important to have the teeth clean, with bacteria and plaque removed prior to retiring.

American College of Chest Physicians Say Thumbs Down

“There is no clinical evidence that over-the-counter expectorants or suppressants actually relive cough. Cough is very common in children; however, cough and cold medicines are not useful in children and can even be harmful,” said Richard S. Irwin, M.D. chair of the guidelines committee and on the faculty of the University of Massachusetts Medical School in Worcester, Massachusetts. “The guidelines also are the most comprehensive evidence-based recommendations for treating cough in children.

“Cough is the number one reason why patients seek medical attention,” Irwin added. “The new ACCP guidelines define how physicians should diagnose and manage cough associated with everything from common cold to chronic lung conditions.”

President of the ACCP, W. Michael Alberts, M.D. supported his colleague’s assertions. “Chronic cough can significantly compromise quality of life for patients, however, patients with chronic cough do not have to continue suffering from their condition,” said Alberts. “The new ACCP guidelines provide clinicians with proven methods of identifying and treating the underlying causes of chronic cough, ultimately leading to more effect management of chronic cough and better quality of life for patients.”

A third colleague, William Brendle Glomb, M.D., who helped put together the guidelines, allowed for the idea that further study is needed. "There are big holes in the scientific literature, and this is one of them," said Glomb. "These products just haven't been studied."

Perhaps, but Glomb still tends to come down on the side of his associates and their argument against using cough syrups. “When children cough,” he said, “it is generally because they need to get out whatever it is that is in there."

Industry Comment

“Our stance,” said Fran Sullivan, spokesman for Wyeth Consumer Healthcare, the company that makes Robitussin products, “is that the FDA [Food and Drug Administration] has reviewed dextromethorphan and guaifenesin and found the two ingredients to be both safe and effective. We don’t believe that consumers would… re-purchase these products if they weren’t efficacious.”

Also, the Consumer Healthcare Products Association (CHPA), a trade group for manufacturers of over-the-counter medications, has concerns about the APPC broad-blanket approach to sweeping cough syrups off the table.

In cough syrups’ defense, the CHPA stated that these products “…provide relief to millions of people each year.” The organization also reiterated that the FDA has approved each of the medicines and noted that the medicines contain ingredients that have been study-proven to help coughs.

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