Vapor rub relieved nocturnal cough, cold symptoms in children

Paul IM. Pediatrics. 2010;doi:10.1542/peds.2010-1601.

Parents reported that children with upper respiratory infections had more nocturnal relief from cough, congestion and sleep difficulty when using vapor rub compared with children treated with a placebo ointment, petrolatum or no treatment.

“Although limited data support many commonly available and [over-the-counter] remedies for cough cold symptoms, the current data indicate that vapor rub helps to fill the therapeutic void,” the researchers wrote. “Despite mild irritant adverse effects, vapor rub provided symptomatic relief for children with upper respiratory infections and allowed them and their parents to have a more restful night.”

The researchers randomly assigned children aged 2 to 11 years with upper respiratory infections to treatment with vapor rub (n=44), petrolatum (n=47) or no treatment (n=47).

Outcomes were improved for groups assigned to treatment (P<.05). Aside from rhinorrhea, all outcomes were most improved among children in the vapor rub group, followed by the petrolatum group, followed by the least amount of improvement in the no treatment group (P<.05).

Vapor rub was better than no treatment for cough severity and cough frequency (P<.01) and marginally better than petrolatum for cough frequency (P=.07). Petrolatum was marginally better than no treatment for cough frequency (P=.09). Vapor rub was better than no treatment for nasal congestion (P=.01).

As rated by parents, children were more able to sleep when treated with vapor rub vs. petrolatum (P=.006) or no treatment (P<.001). Parents of children assigned to treatment with vapor rub slept better than parents of children assigned to treatment with petrolatum (P=.008) or no treatment (P<.001).

For all combined symptoms, vapor rub was better than petrolatum (P=.03) and no treatment (P<.001). Petrolatum was marginally better than no treatment (P=.08).

Adverse effects were more common in the group assigned to vapor rub, with nearly all of them being expected, mild effects.

Now that traditional cough/cold OTC medications are not recommended for use in children younger than 4 years, and with the FDA considering further regulation for use of these products in older children, this evaluation of another OTC product available for URI treatment is welcomed. Paul and colleagues compared a popular topical product containing camphor, menthol, and eucalyptus oil (Vicks VapoRub) to petrolatum and no treatment for symptoms of URI. Compared with petrolatum, VapoRub was beneficial for child and parent sleep and combined symptom score. Benefit for cough frequency and severity were described as marginally better, with P values just >.05 (P=.07 and P=.06, respectively). VapoRub was no better for congestion and rhinorrhea. Adverse effects occurred significantly more in children receiving VapoRub, although they were mild, as they didn’t affect sleep. This controlled trial provides valuable information for a commonly used and easily available product. Clinicians should still advise caution, however, as camphor is a potentially toxic ingredient. Poison centers receive 10,000 calls annually about camphor exposure in children, and ingestion of even the smallest size jar available can be fatal to young children. Clinicians should continue to consider nasal saline and air humidification for nasal congestion, and other symptomatic support. Honey can also be considered for cough.

—Edward A. Bell, PharmD, BCPS

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