Vapor Rub, Petrolatum, and No Treatment for Children With Nocturnal Cough and Cold Symptoms

Abstract

OBJECTIVE-To determine if a single application of a vapor rub (VR) or petrolatum is superior to no treatment for nocturnal cough, congestion, and sleep difficulty caused by upper respiratory tract infection.METHODS-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 according to a partially double-blinded randomization scheme.RESULTS-There were 138 children aged 2 to 11 years who 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.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. Commenting on camphor-containing products, in 1994 the American Academy of Pediatrics Committee on Drugs wrote, "Since alternative agents exist for all indications for camphor therapy, other therapeutic agents that do not contain camphor should be considered." 13 The "alternative agent" for cough and cold symptoms cited by the Committee in 1994, dextromethorphan, was subsequently not recommended by that committee 3 years later in a policy statement on dextromethorphan use. 4 Dextromethorphan continues not to be recommended, 14 and therefore the question of whether clinicians can recommend topical preparations containing camphor, menthol, and eucalyptus oil for URI symptoms in children requires reevaluation. KeywordsWith no contemporary evidence that supports or refutes the efficacy in children with URIs, this study sought to determine if a single application of a vapor rub (VR) or petrolatum is superior to no treatment for nocturnal cough, congestion, and sleep difficulty caused by URIs. We hypothesized that VR or petrolatum would be superior to no treatment for relief of nocturnal symptoms and that VR would be superior to petrolatum. METHODSFrom October 2008 through February 2010, patients were recruited from a universityaffiliated pediatric practice in Hershey, Pennsylvania. Eligible patients were aged 2 to 11 years with symptoms attributed to URIs...