ISPP 2015

Career Opportunities in Pharmacy

The common cold causes a sore throat, headache,
sneezing, a runny nose or nasal congestion, and coughing which usually starts a few days
after the other symptoms, but often develops into the worst symptom and can linger for
a few weeks. Bronchitis causes chest congestion, shortness
of breath, wheezing, and once again, a lingering cough. Both are viral infections so antibiotics don’t
work, but the symptoms can be rough, so, what’s the best medication for treating a cough due
to the cold or bronchitis? Unfortunately, many over-the-counter cough
remedies haven’t been recently tested and when they have been, many are found to be
ineffective. Also, simply taking something for a cough
can make a person feel better, so there’s also a placebo effect at work. In general, there are three ways to study
how well a cough medication works. The first way is a survey that simply asks
people if a medication helped them recover from their cough. The second way is called the challenge method
because healthy people are challenged with citric acid or capsaicin—the molecules that
make hot peppers hot—both of which can induce coughing. Then the medication is given to see if it
reduces the coughing. The third way, cough counting, involves a
person with a cough wearing a recording device that counts the number of coughs they have
before and after they take a medication. This last way is considered the best (yes,
really) by regulatory agencies like the Food and Drug Administration, but the results don’t
always correlate with results from surveys and challenge studies. So, with this in mind, a recent review in
the British Medical Journal took a look at the effect of various over-the-counter cough
medications by looking at all three types of measurements. Now, the availability for each medication
varies by country. For example, codeine is only available with
a prescription and Levodropropizine is not readily available in the United States. That said, codeine doesn’t appear to stop
coughing by any method of measurement, and while Levodropropizine appears to decrease
coughing in subjective and challenge tests, those results aren’t supported by cough
counting studies. Another interesting medication is menthol,
which is thought to reduce cough by being a mild anesthetic. It’s included in a lot of different cough
relief formulation, and works in cough challenge tests, but not in subjective or cough count
tests. In fact, of everything studied there was only
one medication that was effective in studies using cough counting, cough challenges, and
surveys: that medication is Dextromethorphan. Dextromethorphan is believed to help stop
the cough reflex in the brain. It is a widely sold anti-cough medication
and is found in formulations like Vicks DayQuil Cough and Robitussin. While dextromethorphan has been shown to work
better than placebo in a number of adult studies there are a lack of large studies in children,
so it is not clear if this this medication works for them. That said, it is included in a number of formulations
designed for children. As for recommendations to decrease a cough
due to the cold or bronchitis the BMJ review suggested this strategy. First, take agents that are designed to soothe
the throat like cough drops or adding honey to tea. This can help with temporary cough relief,
and is a relatively safe place to start. Next for isolated coughs, a daily dose of
30-60 mg of dextromethorphan is recommended for adults. Finally, coughing due to colds or bronchitis
usually resolves in a few weeks, so if it doesn’t get better it’s important to seek
out a healthcare professional.

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