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Anticholinergics, honey, and antitussives ineffective for cough from acute bronchitis in underpowered study
Clinical Question
Are antitussives, honey, or anticholinergics helpful for symptom relief in patients with an acute bronchitis?
Bottom line
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. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Outpatient (primary care)
Synopsis
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.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Cough treatment
Good to know these treatments have little benefit
Impact assessment
Excellent
The value of placebos
This is an underpowered study which could have been much better if done better. Nevertheless it also undervalues the power of placebo
anticholergenic , honey and anttussive
good to know
Bien que l'étude manque de…
Bien que l'étude manque de puissance, elle vient de nouveau confirmer ce que je pense depuis longtemps. Les gens gaspillent leur argent à acheter des médicaments en vente libre pour tenter de réduire les symptômes de conditions bénignes auto résolutives.
Anticholinergics, honey, and antitussives ineffective for co
Bottom line for me is that I would never adopt the conclusions of any study where half of the subjects did not complete the study. In general, I concur with the conclusions but based on prior research not this study.