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Chest physicians offer new guidelines on treating cough
Scripps Howard News Service


January 11, 2006
Wednesday AM

If you've got a cough from a cold or runny nose, the newest expert advice is not to waste time and money on over-the-counter cough remedies.

Instead, new guidelines from the American College of Chest Physicians suggest that sufferers put their pennies toward a simple antihistamine that usually works to cut off the cough at the source - the upper respiratory system.

"If you've got a cough severe enough to take medicine, you might as well take one that has been shown to work. And there is no clinical evidence that OTC cough expectorants or suppressants actually relieve cough," said Dr. Richard Irwin, head of the committee that wrote the new guidelines.




"There is considerable evidence that older antihistamines help to reduce cough, so unless there's some contraindication for taking them, people should go with what we know works," added Irwin, who is also a professor of medicine at the University of Massachusetts Medical School.

For those 14 and under, the guidelines suggest skipping both cough medicine and cold remedies due to the concern over side effects. "In most cases, a cough that is unrelated to chronic lung conditions, environmental influences or other specific factors will resolve on its own," Irwin said.

The guidelines also urge adults up to age 65, using money saved from not buying cough medicine, to get a new vaccine that protects them against whooping cough, or pertussis. It is a highly contagious type of bacteria-generated cough that gets its name from the whooping noise victims make when they cough.

"Most of us think of whooping cough as a childhood disease, yet 28 percent of whooping cough in the United States is in adults," Irwin said. "Although most of us were vaccinated against whooping cough when we were children, the older vaccine only gives protection for less than 10 years."

Because the older vaccine caused severe side effects in older children and adults, booster shots have never been recommended.

But now, there's a new, adult-safe form of the vaccine that's been out in Europe for a decade and was recently approved in the United States. Doctors say that because antibiotics only work against pertussis in the first few weeks of infection, preventing the disease with the vaccine is the only way to eventually eliminate that disease.

Antibiotics are often not given early in a whooping-cough infection, largely because doctors don't expect to see it in adults and fail to diagnose it in time. Whooping cough can bring serious complications, such as vomiting, broken ribs, passing out and passing the infection on to others through the violent coughing spasms.

Overall, the guidelines, published Tuesday in the January issue of the society's journal, Chest, make more than 200 new or updated recommendations for dealing with short-term, medium-range (three to eight weeks) and chronic cough - more than eight weeks in duration.

"Cough is the number one reason why patients seek medical attention," Irwin said. Federal surveys indicate that Americans go to the doctor for a cough about 30 million times a year.

"Physicians who used evidence-based medicine have a 90 percent or better chance of figuring out what the cause of a cough is and giving patient medications that will work to successfully treat that condition. But if (patients have) seen one person after another and they're not getting any better, then they should seek out a cough specialist," Irwin added.

The guideline update, the first done since 1998, also addresses other common cough factors, such as asthma and gastroesophageal reflux disease (GERD), along with smoking and the side effects of some drugs.

There are a number of specific guidelines for managing cough in children, although Irwin said there aren't enough good studies about most aspects of treating cough in children to make recommendations with as much certainty as the panel did for adults.

"We don't know all we need to know about treating children, particularly dosing for medicines at different ages and sizes, but we know a lot more than we did seven years ago, too," Irwin said.


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Contact Lee Bowman at BowmanL(at)

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