"Long before it's in the papers"
January 28, 2015


Honey may be best for cough, study finds

Dec. 5, 2007
Courtesy JAMA and Archives Journals
and World Science staff

A bit of buck­wheat hon­ey beat the lead­ing over-the-coun­ter chil­dren’s cough rem­edy in re­liev­ing kids’ cough and as­so­ci­at­ed sleep trou­bles, a study has found.

But the re­search—though pub­lished in a re­spected med­i­cal jour­nal—was funded by the U.S. hon­ey in­dus­try. Its au­thors rec­om­mend­ed fur­ther stud­ies to con­firm the re­sults, while not­ing that safe­ty and ef­fi­cacy ques­tions have aris­en around over-the-coun­ter kids’ cough med­i­cines.

(Courtesy U.K. Honey Association)

“Cough is the rea­son for nearly three per­cent of all out­pa­tient vis­its in the Un­ited States, more than any oth­er symp­tom,” they wrote in the re­port. “It most com­monly oc­curs in con­junc­tion with an up­per res­pi­ra­to­ry tract in­fec­tion,” and of­ten dis­rupts sleep.

The study ap­pears in this mon­th’s is­sue of the Ar­chives of Pe­di­at­rics & Ad­o­les­cent Med­i­cine, pub­lished by the Amer­i­can Med­i­cal As­socia­t­ion. The Na­t­ional Hon­ey Board­—an in­dus­try-funded agen­cy of the U.S. De­part­ment of Agri­cul­ture—paid for the re­search.

The most com­monly used over-the-coun­ter chil­dren’s cough rem­e­dy is dex­tro­meth­or­phan, though it’s un­sup­ported by the Amer­i­can Acad­e­my of Pe­di­at­rics or the Amer­i­can Col­lege of Chest Physi­cians, the stu­dy’s au­thors not­ed. “In many cul­tures, al­ter­na­tive reme­dies such as hon­ey are used,” they added in the re­port.

The re­search­ers, Ian M. Paul and col­leagues at Penn State Col­lege of Med­i­cine, stud­ied 105 chil­dren aged two to 18 with up­per res­pi­ra­to­ry tract in­fec­tions who were sick for a week or less and suf­fered symp­toms at night. 

They were ran­domly as­signed to re­ceive an age-appropriate dose of hon­ey, dex­tro­meth­or­phan or no treat­ment for one night with­in half an hour of bed­time. The par­ents were asked to fill out a sur­vey as­sess­ing their child’s cough and sleep the night be­fore and the night af­ter treat­ment.

The sur­vey an­a­lyzed cough fre­quen­cy, cough sev­er­ity and its both­er­some­ness to the child, the child’s sleep and to par­en­ts’ sleep. “Hon­ey was sig­nif­i­cantly su­pe­ri­or to no treat­ment for cough fre­quen­cy and the com­bined score, but dex­tro­meth­or­phan was not bet­ter than no treat­ment for any out­come,” Paul and col­leagues wrote.

“While our find­ings and the ab­sence of con­tem­po­rary stud­ies sup­port­ing the use of dex­tro­meth­or­phan con­tin­ue to ques­tion its ef­fec­tive­ness for the treat­ment of cough as­so­ci­at­ed with up­per res­pi­ra­to­ry tract in­fec­tions, we have now pro­vid­ed ev­i­dence sup­port­ing hon­ey, which is gen­er­ally re­garded as safe for chil­dren old­er than one year, as an al­ter­na­tive,” the au­thors con­clud­ed. 

“While ad­di­tion­al stud­ies to con­firm our find­ings should be en­cour­aged, each cli­ni­cian should con­sid­er the find­ings for hon­ey, the ab­sence of such pub­lished find­ings for dex­tro­meth­or­phan and the po­ten­tial for ad­verse ef­fects and cu­mu­la­tive costs as­so­ci­at­ed with the use of dex­tro­meth­or­phan.”

In a 2004 stu­dy, Paul and col­leagues found that nei­ther dex­tromethor­phan nor di­phen­hy­dra­, anoth­er com­mon com­po­nent of cold med­ica­t­ions, per­formed bet­ter than a pla­ce­bo at re­duc­ing night­time cough or im­prov­ing sleep qual­ity. 

Some cul­tures have used hon­ey for cen­turies to treat up­per res­pi­ra­tory in­fec­tion symp­toms like cough, and it’s con­sid­ered safe for chil­dren over a year old, the re­search­ers said. Hon­ey soothes on con­tact, they added, and con­tri­butes to wound heal­ing, pos­sibly through its well-es­tab­lished an­ti­mi­cro­bi­al and an­ti­ox­i­dant ef­fects.

* * *

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A bit of buckwheat honey beat the leading over-the-counter children’s cough medicine in relieving kids’ cough and associated sleep troubles, a study has found. But the research—though published in a respected medical journal—was funded by the U.S. honey industry, and its authors recommended further studies to confirm the results. “Cough is the reason for nearly three percent of all outpatient visits in the United States, more than any other symptom,” they wrote in the report. “It most commonly occurs in conjunction with an upper respiratory tract infection,” and often disrupts sleep. The study appears in this month’s issue of the Achives of Pediatrics & Adolescent Medicine, published by the American Medical Association. The National Honey Board—an industry-funded agency of the U.S. Department of Agriculture—paid for the research. The most commonly used over-the-counter children’s cough remedy is dextromethorphan, though it’s unsupported by the American Academy of Pediatrics or the American College of Chest Physicians, the study’s authors noted. “In many cultures, alternative remedies such as honey are used,” they added in the report. The researchers, Ian M. Paul and colleagues at Penn State College of Medicine, studied 105 children age two to 18 with upper respiratory tract infections who were sick for a week or less and suffered symptoms at night. They were randomly assigned to receive an age-appropriate dose of honey, dextromethorphan or no treatment for one night within half an hour of bedtime. The parents were asked to fill out a survey assessing their child’s cough and sleep the night before and the night after treatment. The survey analyzed cough frequency, cough severity and bothersomeness of the cough to the child, the child’s sleep and to parent’s sleep. “Honey was significantly superior to no treatment for cough frequency and the combined score, but dextromethorphan was not better than no treatment for any outcome,” Paul and colleagues wrote. “Comparison of honey with dextromethorphan revealed no significant differences.” “While our findings and the absence of contemporary studies supporting the use of dextromethorphan continue to question its effectiveness for the treatment of cough associated with upper respiratory tract infections, we have now provided evidence supporting honey, which is generally regarded as safe for children older than one year, as an alternative,” the authors concluded. “While additional studies to confirm our findings should be encouraged, each clinician should consider the findings for honey, the absence of such published findings for dextromethorphan and the potential for adverse effects and cumulative costs associated with the use of dextromethorphan.” In a 2004 study, Paul and colleagues found that neither dextromethorphan nor diphenhydramine, another common component of cold medications, performed better than a placebo at reducing nighttime cough or improving sleep quality. Some cultures have used honey for centuries to treat upper respiratory infection symptoms like cough, and it’s considered safe for children over a year old, the researchers said. Honey soothes on contact, they added, and contributes to wound healing, possibly through its well-established antimicrobial and antioxidant effects.