By James Janega
CHICAGO TRIBUNE

January 10, 2006

CHICAGO – The American College of Chest Physicians yesterday revealed an open secret in the medical community: Over-the-counter cough suppressants don't work, they say, casting doubt on the billions spent every year to fight the common cold's most irritating symptom.

"We've known this for a while," said Dr. Richard Irwin, chairman of the cough guidelines committee that conducted a new review of existing studies and decided the time had come to inform the masses.

KENNETH LAMBERT / Associated Press The nation's chest physicians report that despite the billions of dollars spent every year in this country on over-the-counter cough syrups, most such medicines do little if anything to relieve coughs.

For sufferers of "acute cough from cold," the group suggests you ignore over-the-counter medicines with the active ingredients dextromethorphan and the expectorant guaifenesin.

The effects of guaifenesin aren't clear, they said. The two cough suppressants had "limited efficacy," they wrote, plus other problems.

Products with just the first of those tongue-twisting ingredients include Robitussin Maximum Strength Cough Suppressant, Vicks 44 Cough Relief, Benylin Adult Formula Cough Suppressant and Sucrets 8 Hour Cough Suppressant.

The National Institutes of Health's online service Medline Plus says an additional 150 or so other popular products also use dextromethorphan – alone or in combination – such as some Coricidin, TheraFlu and Alka-Seltzer cold medications.

Irwin said that not only are such medicines ineffective at treating coughs due to colds – the most common cause of coughs – they also can lead patients to delay seeking treatment for more serious coughs, including whooping cough.

The guidelines strongly recommend that adults receive a new adult vaccine for whooping cough, approved last year.

"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."

The good news is that some older antihistamines work against coughs from colds, the chest doctors said yesterday. Mostly, the antihistamines are the ones that cause drowsiness.

They include the diphenhydramine in Benadryl, the brompheniramine in Dimetapp, and chlorpheniramine in Chlor-Trimeton, and many other products by the same over-the-counter pharmaceutical giants marketed for allergy and sinus woes.

All the drugs, either recommended by the chest doctors or not, have been declared "safe and effective" by the U.S. Food and Drug Administration, which at least one drug company seized on.

"Our reaction to this is that dextromethorphan has been deemed safe and effective by the FDA, and that Robitussin has a long history of use by numerous consumers. And we feel that if they truly didn't work, people wouldn't purchase and re-purchase it," said Francis Sullivan, spokesman for Wyeth Consumer Healthcare.

While true, there is more to say about cough suppressants, doctors say.

That cough you thought you knocked back in a few days with that $7 cough syrup? Coughs from colds go away in two or three days anyway.

"The presumption I think on the public's perception is that, 'These things do work, so let me do something to help myself or my child feel better now,' " said Dr. Russell Robertson, chairman of the Department of Family Medicine at the Northwestern University School of Medicine.

They don't, Robertson said.

The guidelines were published in this month's issue of Chest, the American College of Chest Physicians' journal, released yesterday. The recommendations have been endorsed by the college, the American Thoracic Society and the Canadian Thoracic Society.

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