Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind, Randomised, Placebo-Controlled Trial facilitated by Dr Jane Smith

Robina Town Centre Journal Club Summary

13 Dec 2013

Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind, Randomised, Placebo-Controlled Trial

Facilitated by Dr Jane Smith

Background

Upper respiratory infections (URIs) with nocturnal cough are common health problems in children that cause significant distress to both caregivers and patients. Although URIs frequently resolve naturally without treatment, parents often give over-the-counter medications to their children. These commonly contain drugs such as pseudoephedrine, antihistamine, and dextromethorphan, all of which have risks when used in young children1. They also lack proven efficacy, and are therefore not recommended by professional organisations.

Home remedies such as honey could provide a safe alternative to treat the symptoms associated with URIs. Indeed, honey is recommended as cough medication by the World Health Organisation and its efficacy was proven in 2 studies. However, one of these studies only tested one type of honey and the other study was not blinded.

Paper presented

The paper presented2 was a double-blind randomised placebo-controlled study comparing the effect of a single dose (10g, given 30 minutes before bed) of one of three different types of honey (eucalyptus, citrus and labiatae) with placebo treatment (Silan date extract) on children’s cough symptoms and children’s and parent’s sleep. 270 children aged 1 to 5 years from 6 general pediatric community clinics with URIs and nocturnal cough for ≤ 7 days completed the single-night trial. Parents provided a subjective assessment of their child’s cough by self-completing a 5-item questionnaire prior to conducting the trial and were asked the same questions again over the telephone after the overnight treatment. The survey used a 7-point Likert scale to grade cough frequency and severity, the bothersome nature of the cough and child and parent sleep quality.

The results and author’s main conclusions were:

  • For each treatment, all study outcomes improved overnight (by about 1-2 points on the Likert scale)
  • Each of the honey groups had a better response compared with the date extract (placebo)
  • There was no significant difference between the different honeys
  • Honey may be a safe, inexpensive and preferable treatment for cough and sleep difficulties associated with URIs in children.

Discussion

The group of children recruited was representative for the study. There are no details in the methods section about how randomisation was achieved but the baseline patient characteristics were similar in all four groups.

300 children were enrolled but only 270 completed the study. This is a small loss (10%) considering it was a study on unwell children.

Although efforts to blind parents, patients and research assistants were appropriate, it is questionable whether the parents were truly blinded as they could notice differences in the colour and smell of the honey and the Silan date extract. The authors comment that date syrup was selected as the placebo because its structure, brown colour and taste are similar to honey, but it would have been useful to ask parents if they could guess which treatment their child was receiving. The subjective assessment of cough symptoms and sleep quality further limits the study and the authors acknowledge this in their discussion. A more objective method of recording cough frequency and sleep quality could have been achieved by recording coughing and movement during the night using an electronic device or a smartphone App.

Despite these limitations, we concluded that GPs should recommend the use of honey as a safe and inexpensive alternative treatment to alleviate coughing in children with URIs, especially if they are of viral nature.

References

  1. Rimsza ME, Newberry S (2008). Unexpected infant deaths associated with use of cough and cold medications. Pediatrics 122(2):e318-22.
  2. Cohen HA et al. (2012). Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-blind, Randomized, Placebo-Controlled Study. Pediatrics 130; 465-471.

Summary provided by Michele Weber

To read the full article, click on the link below:

Honey cough Pediatrics-2012-Cohen-465-71