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Sunday, 13 September 2009

Cough syrups act little more than placebo in children: Study


Administering cough syrups to children with acute cough might be a fairly common practice in every household, but the effect of medicinal administration might be little more than placebo, a study says.

Published in the latest edition of the Indian Pediatrics Journal, the study which analyses the clinical outcome of cough syrups on children in terms of symptom relief, concluded that there was no difference between various pharmacological agents compared to placebo or non-medicated administrations.

Moreover, the study says cough syrups can also have the risk of adverse effects, suggesting their use should be "discouraged".

"... the symptomatic relief with cough syrups observed in uncontrolled settings is likely to be nothing more than placebo effect," it concluded.

A placebo effect occurs when a treatment or medication with no therapeutic value (placebo) is administered to a patient and the symptoms improve. According to medical experts, the patient's belief sometimes has therapeutic effect.

The study was based on Cochrane Library reviews, which include eight randomised controlled trials with 616 people having cough associated with upper respiratory infection being treated with various pharmacological agents singly or in combination.

The reviewers measured several outcomes that quantified improvement in terms of change in severity or frequency of cough, comfort to the child in terms of impact on sleep, and also included parental assessment of improvement as a measure, the study says.

The study also analysed an additional trial evaluating a mixture of four pharmacologically active products in children and assessing a composite score of symptom relief of runny nose, congestion, pain and cough.

"The trials showed that relief with cough syrups was not only comparable to placebo, but both were of a fairly high magnitude, suggesting significant placebo effect.

"In addition, sleep induced by cough syrups may be mistakenly attributed as a therapeutic rather than side effect, in some cases," the study says.

Besides, another trial that was analysed in the study, showed that dextromethorphan, an anti-tussive drug which is one of the active ingredients in many over-the-counter cold and cough medicines, was "no better than placebo for the treatment of cough".

"There was no difference between various pharmacological agents compared to placebo or no treatment," the study concluded.

While suggesting that the effect of cough syrups was little better than no treatment, the study also says that the frequency and severity of adverse events reported with most pharmacological preparations "disallows exploiting even the placebo effect".

The adverse events "range from insignificant and transient clinical events to serious adverse events and even death in rare instances," it says.

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