Jul
16
COUGH
Trying to ease a cough ough can be a frustrating exper*ence. If it arrived with a cold or another upper respiratory tract infection, it’s likely to go away eventually, but those 2 or 3 weeks of suffering until it does can be miserable. Way back before the end of the last century, Americans could buy cough medicines that worked. Codeine-containing antitussive syrups were widely available without prescription. Physicians also recommended terpin hydrate, an expectorant, from the late 1800s until the early 1990s. In theory, an expectorant simply loosens up the stuff in the lungs and makes it easier to cough up. But many people found that terpin hydrate offered more benefit.
Q.For years I used terpin hydrate as an expectorant when I had a cough. It worked. It was sold over the counter and one small bottle would last me the entire cold season. Over-the-counter cough remedies on the market today are no better than water. They just do NOT work. Is terpin hydrate still available? I’ve never found another cough syrup that works so well, but I can’t find it in my local drugstores.
A. Terpin hydrate was a popular cough medicine from the late 1800s until the early 1990s. Then the FDA banned it on the grounds that it had not been proven effective.
As an expectorant, terpin hydrate was supposed to loosen mucus and relieve coughs. It was derived from natural sources such as oil of turpentine or compounds found in oregano, thyme, and eucalyptus. Terpin hydrate is no longer available in the United States. Instead, you may want to try a different old-fashioned remedy. Vicks VapoRub contains similar ingredients: oil of turpentine, thymol, and eucalyptol. Don’t take it internally. Just rub it on the chest or the soles of the feet to ease a cough.
Another approach is thyme tea. Use 1/2 teaspoon of dried thyme leaves from the kitchen spice shelf per cup of tea. Some people like to add lemon and honey. Others prefer chicken bouillon for flavor. Terpin hydrate was removed from the market because the FDA did not receive enough data to support its use when they were reviewing over-the-counter (OTC) drugs for effectiveness. (A high-ranking FDA official admitted to us off the record that he had used it and found it helpful. But the agency needed real data, not testimonials.) Perhaps the fact that it had been around for so long and no one company had a strong vested interest in it meant that no one wanted to invest in research on tenpin hydrate. Or maybe it really doesn’t work quite as well as people believed. But in any event, after it was banned, Americans needed to look for other cough remedies.
Codeine Cough Medicine
Codeine at prescription doses is generally considered an effective cough suppressant, but even the lower-dose OTC forms are becoming much harder to find. If you have a cough, your doctor might write you a prescription. It is legal in some states for people to buy low-dose codeine cough syrups if they sign for them. Presumably, that step offers extra security against abuse. But even where OTC codeine is legal, many chain drugstores won’t sell it without a prescription. They simply don’t want to be bothered. If you live in a state where codeine may be sold without a prescription, check with an independent pharmacy. Otherwise, ask your physician about a prescription. Codeine can be constipating, and long-term use can lead to dependence. But for a short-term annoying hack, this is a very helpful medication. Codeine not only is a good cough medicine, it also is extremely good for relieving pain. When combined with aspirin or acetaminophen, it practically sets the standard for pain relief. Codeine can also be useful in alleviating diarrhea, though it isn’t necessarily the first choice for that problem.
Side effects: Constipation, drowsiness, upset stomach Downside: Can cause dependence. May require a prescription.
Cost: Approximately $6 to $10 for a bottle.
Dextromethorphan
By far the most readily available cough medicine is dextromethorphan. It is the primary ingredient in most OTC cough syrups, including Robitussin DM (the DM stands for dextromethorphan) and many other popular brands. Dextromethorphan has been almost the only choice for nonprescription cough relief for years. It is considered fairly safe because (unlike codeine) it is not classified as a narcotic. The effectiveness of dextromethorphan has been questioned, however. The American College of Chest Physicians issued guidelines in 2006 on the diagnosis and management of cough that discourage the use of dextromethorphan or any other OTC cough medicine. According to Richard Irwin, MD, the head of the committee that developed the guidelines, “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough.” That’s a pretty discouraging view, since very few coughs actually warrant a doctor’s attention. If the cough has lasted for more than a couple of weeks, or if you are otherwise sick, then you should by all means see your doctor. But a regular cough from a cold probably won’t benefit from anything your doctor can do.
Home Remedies
There’s no good evidence for most of the home remedies that we are going to suggest. No one has done studies to see if thyme tea or horehound drops will really help. On the other hand, these approaches are inexpensive, so you can try them and judge for yourself if they work.
Vicks VapoRub
Vicks VapoRub shouldn’t really be classified as a home remedy. It is, after all, a perfectly respectable OTC product that has been a popular way to treat colds for more than a hundred years. According to the history, North Carolina pharmacist Lunsford Richardson set out to formulate a vaporizing cold’ salve for his own family. His children had come down with bad chest colds and the standard treatments of the day were messy and unsatisfactory.
The result of his effort was Vicks VapoRub. With its distinctive blue jar and unforgettable aroma, Vicks became known around the world as a remedy for congestion and other cold symptoms. It still contains the original formula: menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol, and turpentine oil in a petrolatum base. Parents everywhere rub Vicks VapoRub on their children’s chests to ease their coughs. Many of the herbal oils in this old-fashioned salve seem to help ease a cough. Menthol is found in many cough drops, and thymol has a reputation for fighting cough. VapoRub is even approved by the FDA for relieving congestion and cough. You could apply it to the throat and chest, as the instructions suggest, but go ahead and try it on the soles of the feet for a nighttime cough.
Downside: Not for internal use. Keep away from broken skin. Do not apply inside nostrils. No studies confirm that applying Vicks to the soles of the feet will work to calm cough. Cost:Approximately $6 to $10 for a jar, which will last quite a while
My son continues to have problems with ear infections, although he had tubes put in them at 8 months old. He is now 30 months old and has an ear infection with nasal and chest congestion.
I was looking for home remedies for coughs when I found your Web site. I read the idea of putting Vicks VapoRub on the soles of the feet Within 10 minutes be was asleep without a cough.
We heard from a nurse who had learned from someone in her church that Vicks could be smeared on the soles of the feet to ease a nighttime cough. As she admitted, this sounded a little crazy, but she was desperate enough to try it on her 4-year-old daughter. When she did, they both finally were able to sleep through the night. We don’t know why Vicks on the soles of the feet would work any better than Vicks on the chest. Perhaps it doesn’t. But we do know that we have heard from hundreds of people who have tried this trick and had success. We have used it ourselves and been pleased. Be sure to put on socks to protect the bed sheets. Coughs frequently are a consequence of colds, and chicken soup is a time-honored cold remedy. Beyond its long history of use for this purpose (the Jewish philosopher Maimonides is said to have recommended it), there is even research to demonstrate its value or relieving congestion from colds. So it is little wonder that chicken soup flavored with thyme can be helpful.
Q. My husband recently had a spell of heavy, nonproductive coughing and couldn’t reach his doctor. Robitussin DM didn’t do a thing. He went 2 nights with very little sleep and was miserable. I made him some chicken soup for supper, and after he ate a bowl of it he stopped coughing. During the night he started up again. With more chicken soup, the coughing stopped immediately and he finished the night sleeping well. I recalled what I’d put into the soup, and zeroed in on two herbs from my garden—three fresh sage leaves and some dried thyme. On the Internet I found that sage can calm a cough and thyme has been widely used as cough medicine. I made him 2 cups of thyme tea before he went to bed the next evening and he slept the whole night through. I think our experience shows that thyme is a good remedy to keep around until the doctor calls back.
Thyme
Thyme contains compounds such as thymol and carvacrol. This herb is listed in the PDR for Herbal Medicines as indicated for cough. and bronchitis. One to 2 grams of dried thyme leaves (1/2 to 1 teaspoon) are used to make a cup of tea. The recommended daily dosage is 10 grams spaced over the course of the day. Chicken soup with thyme is one way to get the essence of thyme. Another is to make a cup of thyme tea. Ordinary thyme leaves from the kitchen spice cupboard will work just fine-1/2 teaspoon to a cup of hot water, steeped for about 5 minutes. One reader reported getting a cough remedy over the counter when traveling in Germany. She found it very useful, much better than Robitussin DM, and wondered what it was. The medicine, called Makatussin, came as drops to be put on a sugar cube or in tea and contained Thymianfluidextrakt and Sternanisol. These are extract of thyme and star anise oil.
The German government has approved both herbs for colds and coughs, confirming what our readers have found for themselves.
Other Herbs
A number of other herbs have traditionally been used for uncomplicated coughs. Licorice is classic for sore throat and cough. It can raise blood pressure, so we don’t recommend it for people with hypertension, but for short-term use, it could be helpful. Menthol seems to have been approved by the FDA, since it is found in most OTC cough drops (as well as Vicks VapoRub). Linden flower tea is a European favorite for cough, but may be difficult to find in this country. Elderberry flowers can also be collected and dried for use in tea as a “homegrown” cough remedy. You’d have a hard time finding elderberry flowers in a store, although there are some elderberry products that use the berries themselves, rather than the flowers.
Q. With my high blood pressure, it’s hard to find cold or cough medicine that is safe. My sister recommended black elderberry extract and zinc. It did the trick.
A. Elderberry-flower tea is a traditional remedy for colds and coughs. Many herbalists believe elderberry is more effective than echinacea.
Studies of zinc used against colds have produced mixed results, some positive but others negative. Neither remedy should increase blood pressure, though.
Ginger tea is one of our favorite cold remedies, and it also may help to ease a cough. One animal study found that a component of ginger called shogaol worked at least as well as dextromethorphan against cough. That may mean simply that shogaol is just as good as placebo, now that the effectiveness of dextromethorphan is in question. Nevertheless, ginger tea is tasty and not very expensive.
Another old-fashioned approach to calming a cough is horehound. Candies flavored with this herb are still available in some stores and catalogs (such as the Vermont Country Store) that pride themselves on carrying old-time products. There’s no good research for any of these herbal products, but also no indication that they would cause any serious reactions, either.
Some people find that sucking on a piece of hard candy works quite well to ease a daytime cough, whether or not the candy has any active ingredients such as licorice or menthol in it. One scientist has suggested that part of the reason most cough syrup is sweet is not only to mask the nasty flavor of dextromethorphan, but also to recruit the brain’s own opioids, endorphins, in calming the cough. 161 Since opioids are very effective against cough, this is an appealing hypothesis.
Chocolate
Another possible remedy fora simple cough may surprise you. Chocolate lovers though we are, we never suspected that theobromine, one of the essential components of chocolate and cocoa, would have any benefit against cough. But that is exactly what British researchers found in experiments with guinea pigs.” They gave the guinea pigs citric acid to make them cough, then gave them theobromine purified from cocoa. The theobromine overcame the induced cough. An experiment in humans confirmed that theobromine is also effective against coughs in people.
The question is, how much chocolate does it take, and in what form? Unfortunately, we do not have an answer to that extremely practical issue. The researchers used theobromine alone, which is not available to the rest of us. But all of us have access to chocolate. You could do some experiments of your own to find the most palatable and effective cough-suppressing chocolate. ,
Here’s what pediatrician Alan Greene, MD, says about using chocolate against cough:
How much chocolate would this be? Chocolate preparations vary widely, depending on their cocoa content but dark chocolate often has up to about 450 milligrams of theobromine per ounce. Milk chocolate has far, far less. Two ounces of dark chocolate was about the amount of theobromine used for the adults.
Theobromine has been tested and shown to be effective in suppressing a cough. We don’t know of any way to get theobromine except to eat some chocolate, preferably dark chocolate. Savor it, and remember that it has other health benefits if consumed in moderation.
Side effects: Allergy is possible.
Downside: Dose unknown. Excess chocolate consumption -may lead to weight gain.
Cost: Highly variable, no prescription dispensing fees
Half that maybe plenty for kids (but of course there is still a lotto learn about this marvelous food). Will that much chocolate keep them awake? Even though theobromine is structurally related to caffeine, studies have shown it doesn’t interfere with sleep at those amounts. I used some fine dark chocolate for my own family during our latest viral cough illness, and our coughs disappeared nicely. What a pleasant way to get through a cold!
One other odd cough remedy may be worth a try. This one has not been tested in guinea pigs, but some people find that drinking Concord grape juice helps to ward off colds and ease coughs. There is research demonstrating that Concord grape juice has measurable anti-inflammatory activity. But we don’t know what component of grape juice, if any, might be contributing to its cough-calming effect.
Q. My wife used to get sore throats every winter. They’d hang on for weeks and develop into aloud, hacking cough. Until she recovered, neither of us would get much sleep.
Then I remembered that my sister had a similar problem with her four growing boys. In desperation, she tried a remedy she read about. drinking -red” grape juice regularly.
My wife and I started drinking a glass of Concord grape juice every day fall through spring, and the prob-lem vanished. Since then, we’ve almost never had a bad cough.
We drink half a glass of grape juice and add a half glass of water. Do you know why this works?
A. Purple grape juice has a surprising number of potential health benefits. Research has shown that it can reduce bad cholesterol, lower blood pressure, and help keep blood vessels flexible. There are even some data to suggest that certain ingredients in grapes may support the immune system. Whether this effect would help ward off sore throats and coughs we do not know.
Treating Cough in Children
It is hard on parents to listen to a child coughing away. It may even be hard on the youngster. Sometimes coughs keep them awake at night. And because children are so susceptible to colds and other respiratory tract viruses, they seem to get a lot of coughs. But parents should refrain from rushing to the drugstore for cough remedies. A study published in Pediatrics found that the two main ingredients in OTC cough medicine, dextromethorphan and diphenhydramine, were no better at easing children’s coughs than a placebo syrup was.
According to the lead author, Ian Paul, MD, assistant professor of pediatrics at Penn State Hershey Medical Center, “One of the conclusions you could come to from the results of our study is that these medicines don’t work [for kids]. And in fact this is what evidence-based reviews of the medical literature have found before, that the existing evidence doesn’t support the use of these medicines for acute cough due to a cold . In addition, these medicines are not without risk. According to Dr. Paul, the children who received the standard ingredient in most cough medicines, dextromethorphan (DM), had a harder time falling asleep. That’s the last thing an anxious parent wants for a sick kid.
What to do? For a nighttime cough, we are partial to Vicks on the soles of the feet. Grape juice is certainly popular with most youngsters and would be worth a try.
Concord grape juice has anti-inflammatory properties, but we don’t know of any studies that confirm it has cough suppressant activity.
Side effects: None known.
Cost: About $4 to $5 for a 64-ounce bottle.
ing the day, a lunch of chicken soup with thyme in it would not be amiss. We don’t know for sure that any of these remedies will work for kids, though. We have received many testimonials on vanquishing kids’ coughs with Vicks, however, so we suspect it is likely to help.
Conclusions
These suggestions are not intended for a cough that has lasted longer than a few weeks, or one that is accompanied by fever, pain, or other symptoms of serious illness. They are aimed primarily at the annoying but not dangerous cough that often crops up at the tail end of a cold or the “flu” and hangs in there even though the patient is feeling much better otherwise.
When it comes to coughs and colds, be very cautious about medicating children. Although there are lots of products on the market aimed at kids, very few have been tested on children. And often, when they are tested on children, they don’t seem to work very well. For youngsters, less is definitely better.
• Codeine-containing cough syrup is one of the most effective remedies for cough. It may be difficult to purchase without a prescription. But if your cough is troubling you, ask your doctor to write one. Don’t overuse it, because it can be constipating.
• Vicks VapoRub, with its familiar aroma of menthol, camphor, and eucalyptus, is worth trying. If you don’t want to put it on your chest, try it on the soles of your feet (under your socks) for a cough-free night.
• Chicken soup with thyme is a comfort food that could help control a cough.
• Several herbal teas may be helpful. Try ginger, mint (menthol), elderflower, or linden flower tea. Sweetening the tea slightly with honey may help the brain’s own opioids kick in to help with that cough.
• Suck on hard candy flavored with licorice or horehound.
• The theobromine found in chocolate is active against cough. Perhaps the best way to get it is to melt a square or two of dark chocolate in your mouth.
• Concord grape juice has its enthusiasts, and very little risk.