New Cough Treatment Guidelines

[Sosumi]

http://www.webmd.com/content/article/117/112484.htm

What do you think of the new guidelines? The article states that the expert panel says no evidence exists for OTC treatments efficacy on cough except brompheniramine and pseudoephedrine combo and naproxen/Aleve/Naprosyn?? I haven't read the report yet to figure out which study they're referring to.

We were taught that only dextromethorphan works, but only mildly, and guiafenicin is useless for cough. (Hehe yet you always have that popular contradictory combo of guiafenicin + dextromethorphan. It's interesting because I remember learning that antihistamines have no effect and may make symptoms worse. This article says that nonsedating antihistamines don't work but the first generation may dry up post nasal drip and decrease cough but of course cause drowsiness.

Should pharmacists change how they make their OTC recommendations?

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[sdn1977]

So...I've been thinking about this since the articles came out. Personally...I'm not sure I'd change my recommendations. I usually recommend against a cough product with a decongestant because, IMO, unless the pt is really stuffy...a decongestant dries the pharangeal mucosa and aggravates the cough. An antihistamine...well...that would be tough I think to recommend to anyone who has to work. Funny...perhaps the reason cough syrups work is because most of them taste so bad! (not all...but lots, anyway). When you follow the slug of cough syrup with a huge glass of water, perhaps the water is having the effect as an expectorant-just a thought. A funny "off label" use of guaifenesin from many years back....it used to be in fashion that women with fertility problems were given frequent doses of guaifenesin (ie - 100mg q4h wa) in the attempt to thin the cervical mucosa. Not sure what the clinical outcome was, but I've not seen that done for a long, long time. Fertility treatment has come a long way!

 

[Sosumi]

Actually our professor said the same thing -- she believed the expectorant effect was due to slugging water rather than from guaifenesin itself. It's funny since it's so commonly used and still has new dosage forms out like Mucinex.

From Micromedex on its off-label use in infertility:
In one uncontrolled study, twenty-three of 40 patients showed marked improvement in postcoital tests following treatment with guaifenesin; and fifteen of these 23 patients conceived. Forty women who possessed hostile cervical mucus and were infertile for a minimum of 10 months were studied. Each woman received guaifenesin 200 milligrams orally 3 times daily from day 5 until her basal temperature rose. If the patient showed some improvement in the postcoital test, then the therapy was continued for a minimum of 6 months unless conception occurred first. If there was no sperm survival after 2 treatment cycles, the therapy was considered a failure and was stopped. The treatment of female infertility associated with hostile cervical mucus remains empirical due to the lack of definitive studies in this area. More investigations are needed to elucidate the role of hostile cervical mucus in causing female infertility before intensive therapy to ameliorate hostile cervical mucus to reverse infertility is sought (Check et al, 1982).

 

[WSU2007]

Hello
Has anyone read the actual article in Chest? I would like to but can't seem to find it. I have access to the electronic version of the journal and have searched the last three journals. This reference found on the WEBMD link seems to be non-existantt: Irwin, R.S. Chest, January 2006; vol 129: pp 1-25. Richard S. Irwin, MD, FCCP, chairman, cough management evidence-based guidelines committee, American College of Chest Physicians; chief, division of pulmonary, allergy and critical care medicine, University of Massachusetts Medical School, Worcester, Mass. W. Michael Alberts, MD, FCCP, president, American College of Chest Physicians Usually the article can be downloaded in a PDF format, if anyone has an electronic copy please email it to [email protected]. Thanks!!