Are antitussives, honey, or anticholinergics helpful for symptom relief in patients with an acute bronchitis?
This primary care study is obviously hindered by being underpowered but adds to a literature that fails to find significant benefit to these agents. If someone wants to (understandably) avoid opioids, then honey seems like the safest ineffective alternative.
Plan de l'etude:
Randomized controlled trial (nonblinded)
Outpatient (primary care)
It is good to know what works, but it is also good to know what probably doesn't. These Spanish investigators identified patients with less than 3 weeks of at least moderately severe acute cough (at least 4 on a 7-point Likert-type scale). The 194 participants were randomized to 1 of 4 groups: (1) usual care, (2) ipratropium bromide 2 x 20μg puffs three times daily, (3) one tablespoon of honey 3 times daily, or (4) dextromethorphan 15 mg three times daily. The primary outcome was achieving a score of less than 3 for severity of cough on a 7-point Likert-type scale. Approximately half the patients completed the study, but about two-thirds in each group had some outcome data. Groups were similar at baseline: a mean age of 53 years, two-thirds were women, and a median of 5 days of cough at enrollment. Overall, patients had another 6.3 days of moderate or worse cough after enrollment, ranging from 5.9 to 7.1 days, with no significant difference between groups. The Kaplan-Meier analysis found no significant difference between groups. I would have appreciated an arm with 3 days of hydrocodone, which at least has the benefit of sedating someone with nighttime cough.
Mark H. Ebell, MD, MS
University of Georgia