The efficacy and safety of cough and cold meds

Curious about which cough and cold medicines are safe and actually provide relief? We'll examine cough syrups and cold medications to see which ones are worth taking.

When the leaves are off the trees and the air turns nippy, the sound of coughing probably isn't far off. To relieve the hacking, many people rely on bottles of colourful (and often vile-tasting) cough syrups. However, many doctors now say that most cough remedies aren't worth using.

• One of the first blows against the reputation of these widely used medicines came in 1997, when the American Academy of Pediatrics warned parents that there is no evidence that cough suppressants such as codeine and dextromethorphan work for children. A few years later, a review of 15 studies published in the British Medical Journal cast doubt on whether any form of cough medicine is effective for children or adults.
• In 2006, the American College of Chest Physicians discouraged the use of cough remedies containing suppressants and expectorants on the grounds that there's no proof they do anything.
• But what does help? The only over-the-counter treatments the ACCP recommends for coughs caused by the common cold are antihistamine-decongestant combinations. However, only older antihistamines like brompheniramine seem to help, and these medications may cause drowsiness. Therefore, if the label says "non-sedating," the product won't relieve coughing.
• Inhaling steam from a vaporizer and drinking plenty of fluids may help loosen mucus in the lungs, making it easier to cough up and remove from your body.

• Child cold medications aren't without risk, and there's no evidence that they relieve cold symptoms.
• This finding stunned parents. In 2009, Health Canada told manufacturers to re-label cough and cold medicines with instructions that they should not be used on children under six years old. The reason: very few scientific studies have shown that these remedies are more effective than a placebo at relieving cold symptoms.
• A report by the US Centers for Disease Control and Prevention found that more than 1,500 children under age two in the United States required emergency treatment for illnesses caused by cough and cold medicines during 2004 and 2005. Many of these cases involved accidental overdose, which doctors say often occurs because parents administer more than one cold remedy that contains the same drug.
• Some parents may not mind if cold medications don't ease their child's symptoms as long as they help them get to sleep. However, children are unusually vulnerable to problems linked to excess sedation such as sleep apnea. Furthermore, a heavily sedated child who develops stomach problems in the night may not awaken from nausea and could choke on vomit.
• Other doctors note that the decongestant pseudoephedrine could worsen undiagnosed heart problems in a young child.

The bottom line? It's probably best to limit yourself to a small range of cough syrups and to stop giving children cold medication entirely. Coughs and colds are unpleasant, but toughing them out may in fact be the healthiest option.