Chest physicians: OTC cough syrups don't work

New guidelines also recommend vaccinating adults against pertussis and evaluating patients with chronic cough for GERD and asthma.

By Victoria Stagg Elliott, AMNews staff. Jan. 30, 2006.

Over-the-counter cough expectorants or suppressants are not effective, and physicians should urge their patients who are coughing because of the cold or flu to use first-generation antihistamines, decongestants and anti-inflammatories.

This recommendation comes from the new guidelines for the diagnosis and management of cough in adults and children published by the American College of Chest Physicians in the January issue of the journal Chest.

"There is considerable evidence that older-type antihistamines help to reduce cough, so unless there are contraindications to using these medications, why not take something that has been proven to work?" asked Richard S. Irwin, MD, lead author and professor of medicine at the University of Massachusetts Medical School in Worcester.

This guideline is the latest blow to OTC cough drops and syrups. A review published in the Cochrane Library in August 2004 found that there was no good evidence for or against these preparations.

Still, response from primary care physicians was mixed.

All acknowledged that the efficacy of these products was unclear, but there was disagreement over whether they could still be useful. Some felt that they might play a vital role in helping people -- even if only because of the placebo effect -- at a minimal cost, and dissuading patients from asking for antibiotics. Concern also surrounded the idea of recommending the older drugs that can be sedating and have other, possibly undesirable, side effects.