Vapor rub appears to decrease nighttime cough in children with upper respiratory infections

Article Outline

• Question
• Design
• Setting
• Participants
• Intervention
• Outcomes
• Main Results
• Conclusions
• Commentary
• References
• Copyright

Paul IM, Beiler JS, King TS, Clapp ER, Vallati J, Berlin CM, Jr. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics 2010;126:1092-9.

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Question 

Among children with cough, congestion, and sleep difficulty due to upper respiratory infection, does a single application of a vapor rub (VR), or petrolatum compared with no treatment result in decreased cough and improved sleep?

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Design 

Randomized, partially double-blinded study.

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Setting 

University-affiliated pediatric practice in Hershey, Pennsylvania.

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Participants 

Children 2 to 11 years of age with symptoms attributed to upper respiratory infections (cough, congestion, and rhinorrhea) that lasted 7 days or longer.

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Intervention 

Surveys were administered to parents on 2 consecutive days—on the day of presentation when no medication had been given the previous evening, and the next day when VR ointment, petrolatum ointment, or no treatment had been applied to their child's chest and neck before bedtime.

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Outcomes 

The study was powered to detect differences in the six item survey related to cough, congestion, rhinorrhea, and sleep difficulty.

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Main Results 

138 children completed the trial. Within each study group, symptoms were improved on the second night. Between treatment groups, significant differences in improvement were detected for outcomes related to cough, congestion, and sleep difficulty; VR consistently scored the best, and no treatment scored the worst. Pairwise comparisons demonstrated the superiority of VR over no treatment for all outcomes except rhinorrhea and over petrolatum for cough severity, child and parent sleep difficulty, and combined symptom score. Petrolatum was not significantly better than no treatment for any outcome. Irritant adverse effects were more common among VR-treated participants.

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Conclusions 

In a comparison of VR, petrolatum, and no treatment, parents rated VR most favorably for symptomatic relief of their child's nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection. Despite mild irritant adverse effects, VR provided symptomatic relief for children and allowed them and their parents to have a more restful night than those in the other study groups.

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Commentary 

Acute coughing with head colds is frequent and very troublesome and disturbs both children's and their parent's sleep. Currently only symptomatic relief is recommended including antipyretics, and adequate hydration. Despite a lack of efficacy and recent safety concerns regarding the use of over the counter cough and colds medication, many parents try such medication.¹, ² Topically applied preparations that release aromatic vapors (menthol, camphor, and eucalyptus) have been popular but have not been adequately studied. Paul et al have produced convincing evidence that a single application of VR before bedtime not only reduces coughing, but also improves sleep for both children and parents. VR was able to improve cough frequency and child and parental ability to sleep by at least 1.5 on a Likert-scale of 1 to 7. There are a couple of caveats to these results. First, parents were partially blinded to the presence/absence of an aromatic smell by placing VR on their own upper lip before opening and applying their child's treatment. This blinding was not completely successful as many parents were able to accurately guess the treatment group. Second, the control groups required slightly more other interventions between enrollment and application of treatment, suggesting that these children had more severe symptoms, but this likely was accounted for by the use of baseline data as a covariate. The authors acknowledge these issues and thus caution needs applied when interpreting the results.

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References 

1. American Academy of Pediatrics (AAP). American Academy of Pediatrics urges caution in the use of over-the-counter cough and cold medications. at http://www.aap.org/advocacy/releases/jan08coughandcold.htm. Accessed February 27, 2011.
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2. Shields MD, Bush A, Everard ML, McKenzie S, Primhak R British Thoracic Society Cough Guideline Group. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax. 2008;63(Suppl. 3):iii1–iii5
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