{"id":437,"date":"2014-11-18T16:28:51","date_gmt":"2014-11-18T16:28:51","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=437"},"modified":"2017-08-21T12:10:40","modified_gmt":"2017-08-21T12:10:40","slug":"primary-care-corner-with-geoffrey-modest-md-placebo-for-coughs-in-kids-and-an-adult-perspective","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/11\/18\/primary-care-corner-with-geoffrey-modest-md-placebo-for-coughs-in-kids-and-an-adult-perspective\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Placebo for coughs in kids, and an adult perspective"},"content":{"rendered":"

An interesting article found\u00a0that placebo was more effective than no treatment\u00a0in kids with cough (see\u00a0doi:10.1001\/jamapediatrics.2014.1609<\/strong>). This was a 13 month study in 2 outpatient pediatric practices of kids aged 2-47 months who had nonspecific acute cough of less than 7 days. Parents were given surveys the day before and after the allotted treatment,\u00a0which was either pasteurized\u00a0agave nectar, caramel-colored\u00a0placebo (each given 30 minutes prior to bedtime), or “no\u00a0treatment”. All parents were\u00a0instructed in routine care of the child: hydration, saline nasal spray, and use of acetaminophen\/ibuprofen as needed (ie, the “no treatment” group did get treatment, just not a teaspoon of “meds”). The survey assessed cough frequency, cough severity, congestion severity, rhinorrhea severity and the cough effect on child and parent sleep.<\/p>\n

Results:\u200b<\/p>\n

–119 children completed the study, mean age 23 months, 50% female, 87% white non-Hispanic.<\/p>\n

–No difference in any of these outcomes\u00a0between administering agave nectar or placebo (though agave nectar was\u00a0nonsignificantly better on all outcomes)<\/p>\n

–Significant differences between either one\u00a0of these two treatments and “no treatment”\u00a0for\u00a0all of the above outcomes, all with\u00a0p<0.05<\/p>\n

–Subgroup analysis suggested that the effects of agave nectar over placebo\u00a0were somewhat more pronounced\u00a0in those under 1 year old, though nonsignificant (but only 30 kids <1yo)<\/p>\n

\"Agave\"<\/a><\/p>\n

So, background is that acute\u00a0cough is a remarkably common outpatient complaint in kids and a common reason for a healthcare visit, with nocturnal cough disturbing sleep in 88% of children and 72% of parents. Given current valid\u00a0concerns about adverse events with\u00a0medications as well as\u00a0their\u00a0unclear efficacy in young children (eg antihistamines, decongestants, antitussives), providers have limited medication options. There are some studies showing efficacy of honey, but that should not be used in kids <1yo for concerns about botulism. in above study, they chose agave nectar, since it sort of tastes like honey (though no data that it really works), does have some anti-inflammatory properties (as does honey), but lacks honey’s anti-oxidant effects.\u200b<\/p>\n

So, this article does suggest that placebo has a role for cough in kids (there was an analysis in 2002 suggesting that 85% of the treatment response in adults with cough was attributable to placebo effect). This is really not so surprising. There is an obvious interconnection between an individual’s clinical condition and their psychosocial state. to me, perhaps\u00a0the most obvious example\u00a0is the therapeutic effect of the provider-patient relationship itself. Many patients derive tremendous benefit without specific treatment. There are a slew of articles on the placebo effect, showing both the dramatic efficacy of placebo, the relatively frequent adverse effects as well, and effect even\u00a0studies where the patients\u00a0benefited\u00a0even if\u00a0aware that they were taking a placebo. there was an interesting article<\/a> I ran across last year on this but, one of my favorite articles in the medical literature was an analysis of the CHARM trial,\u00a0a placebo controlled trial of candasartan in patients with congestive heart failure (see\u00a0Lancet 2005; 366: 2005\u201311<\/strong>), which found that those patients who adhered well to their treatment did well and had a lower all-cause mortality, and it didn’t matter whether they were assigned to candasartan or to placebo<\/strong><\/em> — ie,\u00a0people who took their assigned medicine (who were probably more open to having a good effect from that medicine and perhaps more open to “taking care of themselves”) had similarly lower mortality independent of whether their assignment was to “active” medication or not…..<\/p>\n

Geoff<\/p>\n","protected":false},"excerpt":{"rendered":"

Placebo for coughs in kids, and an adult perspective […]<\/p>\n

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