Cough or kill
I am a belligerent skeptic of over-the-counter cough and cold medications. I’ve been this way since well before I ever entertained the idea of being a doctor.
The late Michael Shannon (also known as the ‘dancing doctor‘) nicely summed up the problems with this group of medications:
‘The problem with cough and cold medications are two-fold.
One, they don’t work. We really have abundant scientific data now showing that these preparations do not reduce congestion and do not reduce cough in children who have colds.
Number two, they pose risks. Particularly in children under two, but even in older children, we have so much data now of serious side-effects occurring when parents give these products to young children.Mark Mycyk, March edition Chicago Toxcast
In addition to there being no well controlled scientific studies supporting the clinical efficacy of over-the-counter cough and cold preparations in children, they are potentially lethal. This is emphasized by a recent paper by Dart and colleagues [abstract]. There have been well over 100 identifiable cases of deaths in children from the use and misuse of cough and cold preparations. There have been deaths resulting from therapeutic uses (such as product misidentification or accidental repeated dosing by multipe care-givers) as well as from non-therapeutic uses (such as to make the child sleep, or worse…).
Parents, and doctors speaking to parents, should also remember that in some lung diseases the suppression of cough is actually harmful. However, we can all be reassured that, no matter how frustrating and tiring they may be, coughs and colds in children are commonly due to short-lived viral illnesses that can be adequately treated with fluids and humidity.
Man has an inborn craving for medicine… the desire to take medicine is one feature which distinguishes man, the animal, from his fellow creatures.William Osler, ‘Teaching and Thinking‘ in Aequanimitas
- Carr BC. Efficacy, abuse, and toxicity of over-the-counter cough and cold medicines in the pediatric population. Curr Opin Pediatr. 2006 Apr;18(2):184-8.
- Dart RC et al. Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications. Ann Emerg Med. 2009 Apr;53(4):411-7. [pubmed]
- Schroeder K, Fahey T. Over-the counter medications for acute cough in children and adults in ambulatory settings. The Cochrane Database of Systematic Reviews [cochrane.org]
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC