A study published recently in the British Medical Journal raises doubts about the advice patients receive when they complain of colds or sore throats. Apart from some exceptions, it questions the wisdom of treating these conditions with ibuprofen and suggests steam inhalation does not help either.
Researchers from the University of Southampton in the UK carried out a trial with 889 primary care patients aged 3 and over with acute respiratory tract infections (colds and sore throats). The patients were randomly advised to take either paracetamol, ibuprofen, or both, with and without steam inhalation.
The researchers then assessed symptom severity on days 2-4, plus temperature and antibiotic use, and they noted whether patients sought reconsultations.
The results showed that compared with paracetamol, ibuprofen or ibuprofen and paracetamol combined offered no advantage on the whole to patients with colds or sore throats. They also showed the patients derived no benefit from steam inhalation.
Routinely advising ibuprofen, steam inhalation, not a good idea
Study leader Paul Little, professor of Primary Care Research in the Faculty of Medicine at the University of Southampton, says:
"Paracetamol, ibuprofen or a combination of both are the most common courses of treatment for respiratory tract infections."
But following their findings, he says:
"Although we have to be a bit cautious since these were surprise findings, for the moment I would personally not advise most patients to use ibuprofen for symptom control for coughs, colds and sore throat."
However, he says ibuprofen does appear to help children and those with chest infections.
Regarding steam inhalation, which is often advised as a treatment for respiratory tract infection, he also adds:
"Clinicians should probably not advise patients to use steam inhalation in daily practice as it does not provide symptomatic benefit for acute respiratory infections and a few individuals are likely to experience mild thermal injury."
The trial results suggest around 1 in 50 patients who use steam inhalation to alleviate symptoms of colds and sore throats may suffer mild scalding - but not serious enough to see the doctor.
Perhaps ibuprofen interferes with immune response
Researchers suggest that ibuprofen interferes with the immune response, prolonging cold symptoms.
The study also found that patients advised to take ibuprofen or ibuprofen with paracetamol were more likely to return within a month with unresolved symptoms or new complications, compared with patients advised to take only paracetamol.
Between 50-70% more of the participants who took ibuprofen or ibuprofen with paracetamol came back.
Prof. Little says he was surprised by the results and suggests that treatment with ibuprofen appears to contribute to the progression of the illness.
Although he and his colleagues did not investigate the underlying reason, he speculates it may have something to do with the fact ibuprofen is an anti-inflammatory:
"It is possible that the drug is interfering with an important part of the immune response and leads to prolonged symptoms or the progression of symptoms in some individuals."
Funds from the National Institute for Health Research (NIHR) helped finance the study.In another study published recently in the Annals of Internal Medicine, US researchers describe how they created a home test for strep throat that could eliminate doctor's visits for sore throat.