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Colds and cough

MagazineDecember 2013 (Vol. 24 Issue 9)Colds and cough

Most cold and cough medicines are useless and may do more harm than good, particularly in kids

Most cold and cough medicines are useless and may do more harm than good, particularly in kids. Joanna Evans reveals the safer alternatives that can combat colds naturally.

You might want to think twice before you reach for that cold or cough medicine this winter. Few of them actually work, and according to official drugs regulators on both sides of the Atlantic, many pose serious dangers to children-possibly even putting their

lives at risk.

A recent review by American researchers at the St Joseph Family Medicine Residency in Mishawaka, Indiana, revealed that nearly all the conventional cold treatments they looked at-including antibiotics, inhaled corticosteroids and over-the-counter (OTC) antihistamines, decongestants and antitussives (cough medicines)-simply don't work, either for adults or children (see charts, page 51).

More worrying, the researchers flagged up evidence showing just how dangerous these medicines can be for children-especially the very young. According to data from the American Association of Poison Control Centers, cold and cough medicines are among the top 20 substances leading to death in children under five, the researchers said.1

Even drugs regulators in both the US and UK are urging parents to steer clear of these drugs for their young children. In 2008, the US Food and Drug Administration (FDA) issued a public-health advisory recommending that OTC cold and cough medicines should not be used to treat children less than two years of age "because serious and potentially life-threatening side-effects can occur from such use".

Reports suggest that the drugs can cause a wide variety of adverse effects, the FDA said, including convulsions, rapid heart rates, reduced consciousness and even death.2

These reports of harm arose when children received too much medication, according to the FDA, as in cases of accidental ingestion, unintentional overdose, or medication-dosing error.

But other evidence suggests that serious side-effects can occur even with appropriate dosages.3

Similar concerns over the use of OTC cold and cough medicines have been raised in the UK. Shortly after the FDA's advisory, the UK government's Medicines and Healthcare Products Regulatory Agency (MHRA) warned that OTC cold and cough medicines shouldn't be used in children under six. "There is no evidence that they work and can cause side effects, such as allergic reactions, effects on sleep or hallucinations," the MHRA said.4

Considering that many of the standard cold medicines don't work for adults either,1-and could have sedative effects that make it dangerous to drive or work-you may be better off avoiding cold and cough medicines altogether and looking to one of the many safer, effective alternatives.

If you want to ease symptoms, get well quicker and even slash your chances of getting a cold in the first place, check out our handy guide to the natural remedies that work for both adults and children.

Natural remedies for adults

Treatment

Zinc.If you act fast, taking zinc can cut the number of days you're sick with a cold, according to a recent review of the evidence. The results of 18 trials involving nearly 1,800 people showed that those who took zinc within 24 hours of their symptoms starting shortened their colds by an average of about a day, compared with those who didn't take the mineral. Zinc lozenges at a dose of 75 mg/day or higher were most effective, reducing the length of a cold by an average of around two days. However, possible side-effects include nausea and a bad taste.5

Another review found zinc acetate lozenges to be twice as good as zinc gluconate lozenges-reducing a cold's duration by nearly half.6

Suggested dosage: 75 mg/day (zinc acetate lozenges)

Warning: Avoid zinc nasal sprays as they may result in a permanent loss of sense of smell.1

Zinc acetate lozenges were a better treatment for colds than zinc gluconate lozenges in one trial, reducing a cold's duration by 42 per cent compared with 20 per cent

Pelargonium sidoides.The root extract of this South African plant, also known as Umckaloabo, is used as cold and flu medicine under various brand names, including Kaloba (available from www.schwabepharma.co.uk) and Umcka (available from www.vitaminsuk.com). When put to the test in one high-quality trial, nearly 80 per cent of those taking it were cured of their cold after 10 days, compared with a cure rate of just over 30 per cent in the placebo group.

P. sidoidesalso seems to reduce the severity of a range of cold symptoms such as sneezing, congestion, a sore throat, cough and headache.7

Suggested dosage: 30 drops three times daily (alcohol root extract)

Echinacea purpurea.The results of clinical trials on this herb for colds have been mixed, probably because different species and plant parts were used. But a recent review reported that Echinacea purpurea is the most consistently useful variety for the common cold. It proved effective in five out of six trials, significantly easing symptoms and cutting the course of a cold by up to four days.8 Taken as a herbal tea, Echinacea appears to be effective for treating flu symptoms too.9

For best results, take this herb at the first sign of illness.

Suggested dosage: 4 mL twice daily (solution of pressed juice of aerial parts

and alcohol)

Andrographis paniculata.This herb contains bitter constituents thought to have immune-boosting and anti-inflammatory actions. Several high-quality trials suggest that taking this

herb when a cold strikes can significantly reduce the severity of your symptoms.10

Suggested dosage: 200 mg/day

Vitamin C.Although a review of several trials concluded that vitamin C is ineffective for treating colds, whether or not it works may have all to do with the dose. One large trial in adults reported a reduction in cold duration with a single 8 g dose of vitamin C given on the first day of illness; half that dose had less of an effect. The researchers also found that more people in the high-dose group had 'short colds'-colds lasting a single day-compared to people in the lower-dose group (46 per cent vs 39 per cent).11 A drawback with high-dose vitamin C, though, is that it can cause gastrointestinal symptoms like diarrhoea. Taking a buffered form of vitamin C, such as magnesium ascorbate, may reduce the risk of this effect, as might taking the vitamin in divided doses.

Suggested dosage: 8 g/day in divided doses or as magnesium ascorbate

A single high dose (8 g) of vitamin C has been found to significantly cut a cold's duration; half that dose had less of an effect.

Prevention

Vitamin C.There's a lot more evidence in favour of taking vitamin C before a cold strikes. It probably won't cut the number of colds you get, but when taken as a daily supplement, it can reduce the amount of time you're sick when you do get a cold. When 31 placebo-controlled trials involving more than 11,000 participants were pooled together and analyzed, regularly taking vitamin C was associated with an 8 per cent reduction in cold duration. Vitamin C takers also had less severe colds, the researchers found.11

Suggested dosage: 1-2 g/day

Probiotics.Known for their immune-boosting properties, these friendly bacteria appear to help stave off colds when taken as just-in-case prevention. A review of 10 high-quality trials including nearly 3,500 people found that taking probiotics as either yoghurt or supplements led to 12 per cent fewer colds than with a placebo. Probiotic takers also used fewer antibiotics to treat colds.12

Although it's not clear what dosages and types of probiotic are best for preventing colds, the evidence suggests that multi-strain probiotics are more effective than single-strain preparations.13

A review of 10 trials involving nearly 3,500 people found that taking probiotics as either yoghurt or supplements led to 12 per cent fewer colds.

Garlic.A natural antibacterial, garlic might be worth trying for cold prevention.14 In a trial of 146 volunteers, one capsule a day of an allicin-containing garlic supplement led to 63 per cent fewer colds and 70 per cent fewer sick days compared with those taking a placebo.15

Suggested dosage: 180 mg/day allicin

Exercise.If you need another reason to get up off the sofa this winter, how about fewer sick days? US researchers found that adults who are more active during the autumn and winter months spend three and a half fewer days suffering with colds and flu compared to their more sedentary counterparts. Regular exercisers also tend to have milder symptoms when they do get ill, the researchers discovered.16

Aim for at least 20 minutes of moderate aerobic exercise-such as swimming, jogging or cycling-on five or more days a week.

Natural remedies for children

Treatment

Zinc.Just like adults, when children from one to10 take zinc within the first day of cold symptoms starting, it can shorten the time they're sick.5 Zinc sulphate seems to be the formulation that causes the fewest side-effects when taken as a syrup.1

Suggested dosage: 15 mg/day (zinc sulphate syrup)

Pelargonium sidoides.This herbal remedy may help resolve cough and sputum (mucus) production, according to studies of children aged one to 18,1 plus relieve a sore throat.17

Suggested dosage: 10-30 drops/day (depending on age)

Honey.This simple home remedy is another useful cough-fighter. In a trial of more than 100 children aged between two and 18, those who received a single dose of raw buckwheat honey (available from healthfood shops and online) coughed less and had fewer sleep difficulties than children given an antitussive or no treatment.18

Suggested dosage: Ages two to five years: 2.5 mL; six to 11 years: 5 mL; 12 to 18 years: 10 mL

Warning: Honey should not be given to babies under a year old as it may contain bacteria that's harmful to infants.

Buckwheat honey can ease children's coughs and help them get a good night's sleep

Saltwater nasal rinsing.Oprah Winfrey is a fan of this technique, where you use a container called a neti pot filled with a saltwater solution to flush out your nasal passages. When tested in children aged between six and 10 with a cold or flu, saline nasal irrigation, as it's officially known, helped to soothe sore throats, thin nasal secretions, improve nasal breathing and reduce the need for nasal decongestants and mucolytics (mucus looseners). The children were also less likely to get sick again.1,19 Neti pots and the mineral salts to use with them are available from chemists, healthfood shops and online.

Using a neti pot to flush out your nasal passages can improve breathing and soothe a sore throat

Prevention

Zinc.Giving kids a daily dose of zinc for at least five months may help prevent colds. Children who took zinc sulphate tablets throughout the winter slashed their number of colds, days off school and prescriptions for antibiotics by more than half in one placebo-controlled study.20 Similar, although not as dramatic, results were seen in another trial using zinc sulphate syrup.21

Suggested dosage: Ages one to 10 years: 15 mg/day zinc sulphate in syrup; six to 16 years: 10 mg/day zinc sulphate as tablets

Vitamin C.While it may not stop your child or grandchild getting a cold in the first place, a daily dose of C taken as a preventative could shorten a cold when it hits-by up to 18 per cent-and also reduce its severity.11

Suggested dosage: 1-2 g/day

Probiotics.Giving young children healthy bacteria like Lactobacillus acidophilus NCFM, alone or combined with Bifidobacterium animalis, during the winter months can help fend off fevers, coughs and runny noses, according to studies in three- to five-year-olds.1, 22

Suggested dosages: 1 g (1 x 1010 colony-forming units, or CFUs) mixed with 120 mL of milk twice daily; if cows' milk is an issue, try using rice, oat or almond milk

References

1

Am Fam Physican, 2012; 86: 153-9; Clin Toxicol [Phila], 2010; 48: 979-1178

2

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116839.htm; http://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm263948.htm

3

Clin Pediatr Emerg Med, 2012; 13: 292-9

4

www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON038908

5

Cochrane Database Syst Rev, 2013; 6: CD001364

6

Open Respir Med J, 2011; 5: 51-8

7

Explore [NY], 2007; 3: 573-84

8

Can Fam Physician, 2011; 57: 31-6

9

J Altern Complement Med, 2000; 6: 327-34

10

Phytomedicine, 2010; 17: 178-85; 1999; 6: 217-23; 1997; 3: 315-8

11

Cochrane Database Syst Rev, 2013; 1: CD000980

12

Cochrane Database Syst Rev, 2011; 9: CD006895

13

Eur J Nutr, 2011; 50: 1-17

14

Pharmacogn Rev, 2010; 4: 106-10

15

Adv Ther, 2001; 18: 189-93

16

Br J Sports Med, 2011; 45: 987-92

17

Altern Ther Health Med, 2003; 9: 68-79

18

Arch Pediatr Adolesc Med, 2007; 161: 1140-6

19

Arch Otolaryngol Head Neck Surg, 2008; 134: 67-74

20

Iran J Pediatrics, 2009; 19: 376-80

21

Acta Paediatr, 2006; 95: 1175-81

22

Pediatrics; 2009; 124: e172-9

What doesn't work: a review of the evidence

A review of prescription and over-the-counter (OTC) cold treatments for adults and children by researchers at the St Joseph Family Medicine Residency in Mishawaka, Indiana, USA, revealed that most of the ones they looked at simply don't work. Their analysis included randomized controlled trials (RCTs), the 'gold standard' for scientific evaluation, and systematic reviews by the Cochrane Collaboration, an independent organization that synthesizes and reviews available high-quality evidence on a particular topic.

Here's a summary of what they found.1

Medicines not effective for the common cold in children

Medicine

Evidence

Findings

Antibiotics

Cochrane review of four studies

No difference in persistence of symptoms vs placebo

Carbocysteine

Cochrane review of three RCTs

No significant difference in cough, shortness of breath or overall general health vs placebo

Dextromethorphan

One study

No better than placebo for nighttime cough or

sleep quality

Diphenhydramine (Benadryl)

One study

No better than placebo for nighttime cough or
sleep quality

Low-dose inhaled corticosteroids

Cochrane review of two studies

No reduction in number of episodes requiring oral corticosteroids, emergency department visits, hospital admissions, the frequency of wheezing or duration of episodes

Oral prednisolone

One RCT of a five-day course

No significant difference in length of hospital stay, symptoms or hospital readmission for wheezing vs placebo

OTC antihistamines

Cochrane review of two studies

No more effective than placebo for cough

OTC antihistamine with decongestant

Cochrane review of two studies

No more effective than placebo for cough

OTC antitussives

Cochrane review of three studies

No more effective than placebo for cough

OTC antitussive and bronchodilator

Cochrane review of one study

No more effective than placebo for cough

Medicines not effective for the common cold in adults

Medicine

Evidence

Findings

Antibiotics

Cochrane review of nine RCTs

No difference in symptoms vs placebo

Antihistamines (sedating and non-sedating)

Cochrane review of 35 RCTs

No more effective than placebo

Codeine

Cochrane review of two RCTs

No more effective than placebo for cough

Intranasal corticosteroids

Two RCTs

No more effective than placebo


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