Episode 120: PREMIUM - Two interesting studies for your patients with coughs and colds
In Episode 120, Mike and James, in an attempt to truly make this a PREMIUM podcast, elicit Tina Korownyk to yet again help us unravel the mysteries of medicines. In this podcast, we report on two new studies that look at two old therapies for cough and cold symptoms (Vapor Rub and Zinc).
Comments
Long time listener, first
Long time listener, first time caller here... I'm a little disappointed that a more critical eye was not applied to the VaporRub study in Pediatrics 2010 -especially by the Pediatrics editorial board.
Ignorning that the study size was small, randomization was nearly impossible, and funding was questionable, I'm most concerned that the results were reported in such a way that a NNT could not be calculated. Sure, the average improvement in a cough score was statistically significant, but it tells us not what percentage of patients experienced a clinically significant difference. (i.e., a smaller number of poorly blinded individuals in the VaporRub group might have reported a larger benefit, while a larger number of individuals in the control groups might have reported consistently smaller benefits -but we'll never know). After reading the study, we have no idea if we need to treat 5 or 5000 to reduce the cough score by 1 or 2 points...
What we do know is that children and their parents will almost universally recover from upper respiratory infections without sequelae. And VaporRub contains menthol and camphor, theoretically and (by case reports) actually associated with exacerbations of asthma and seizures in susceptible individuals -groups who were excluded from this study. And a high rate of adverse effects were noted (however minor) while attempting to treat the symptoms (not the cause) of a benign and self-limited condition.
This was a marketing study of questionable significance that managed to find a professional audience. The lay press has been so kind as to disseminate this information as somehow "medically endorsed" without any warning of the possible harms.
We all want to find the cure to the common cold (and its symptoms), but this isn't it. Time is.
saline
I've tried to find any evidence to support this approach and realized it would be impossible to do a trial on it, but my simple suggestion to most people with coughs and colds is:
1) don't waste your money on most OTC things--if you have honey in the house and you like it, try it, but o/w don't go out and get anything
2) most coughs come from your nose dripping down into your throat (or at least, that's my theory, supported by the "clinical evidence" that you never hear anything in the lungs other than upper a/w types of sounds during a cold, and it gets worse at night when you lay back and all those secretions pool and irritate your upper a/w and make you cough), so put a squirt of saline in your nose (buy it OTC for a buck or make it yourself 1/4 tsp salt in a 1/2 cup water and a pinch of baking soda to make it less irritating). Squirt it in with a baby medicine syringe and aim straight back, not up where all the "irritation" receptors are (technical term, of course). There are some trials on saline rinses for sinusitis but not for URTI, as it's pretty hard to make a "placebo"--?squirt air or maybe squirt some Vick's?
3) Come in if you're short of breath (I think that's more likely to indicate some pathology of some sort)
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