NORTHBROOK, Ill., Jan. 10 - Just say no to over-the-counter cough remedies, according to new guidelines issued by the American College of Chest Physicians (ACCP) here.

"There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough," said guidelines chair Richard S. Irwin, M.D., of the University of Massachusetts Medical School in Worcester, Mass. The guidelines were published as a supplement to the January issue of Chest.

Products containing the expectorant guaifenesin or the cough suppressant dextromethorphan, or both, don't treat the underlying cause of cough, the guidelines noted.

The new guidelines are a comprehensive set of recommendations for the diagnosis and management of cough in both children and adults, and include more than 200 specific recommendations for dealing with cough related to conditions ranging from the common cold to chronic airway disease.

According to the ACCP, the guidelines are the first to provide specific evidence-based recommendations for the diagnosis and management of cough in children.

For example, the guidelines strongly recommend against the use of OTC cough and cold medications in children 14 years-old and younger.

"Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful," Dr. Irwin said "In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own."

The ACCP says that nearly 30 million of the estimated 829 million annual visits to office-based physicians in the United States are for cough.

Common causes of chronic cough include upper airway cough syndrome, asthma, gastroesophageal reflux disease (GERD), and side effects from medications (e.g., ACE inhibitors for high blood pressure).

Among the specific recommendations are:


* In children with cough, cough suppressants and other over-the-counter cough medicines should not be used because they can cause significant morbidity and mortality.

* Patients who are suspected of having an upper airway cough syndrome induced cough but who don't respond to empiric therapy with antihistamines or decongestants, or both, should undergo sinus imaging to rule out chronic sinusitis.

* Non-specific cough in children may resolve spontaneously, but children should be re-evaluated to rule out the emergence of specific causes.

* Children with chronic productive purulent cough should be evaluated to rule out bronchiectasis and to identify underlying and treatable causes such as cystic fibrosis or immune deficiency syndromes.