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Honung effektiv mot hostan

07 december 2007.

Lyssna på farmor - ge honung mot hostan. Farmor var inte helt fel ute – honung hjälper mot hosta. Det visar en färsk amerikansk undersökning. "Det kan vara värt att prova som ett alternativ", säger Roland Sennerstam, docent och överläkare på Astrid Lindgrens barnsjukhus.

Studien omfattade 105 barn med hosta. En tredjedel av dem fick honung, en tredjedel fick hostmedicin med det verksamma ämnet dextromorfan, ett ämne som dock inte återfinns i de hostmediciner som säljs receptfritt i Sverige, och en tredjedel av barnen fick ingenting mot hostan.

Barnen som fick honung mot hostan uppvisade snabbast bättring. 
- Ge barnen lite tid och de kommer att må bättre, säger Pat Jackson Allen, professor vid Yale, till USA Today.

En tesked honung i varmt vatten kan alltså vara en riktig dunderkur när barnet är förkylt. Man ska dock inte ge honung till barn yngre än ett år eftersom det finns en liten risk att de kan drabbas av spädbarnsbotulism, en mycket allvarlig förgiftning orsakad av bakterien Clostridium Botulinum som bildar ett livsfarligt toxin. 


- Honung är nyttigt, det blir lite varmt och kan lindra hostan. Det lugnar ner slemhinnorna och luftrören, säger Roland Sennerstam, docent i pediatrik och överläkare på Astrid Lindgrens barnsjukhus. 
- Det kan vara värt att prova som ett alternativ. Men det finns inga underverk mot hosta, den läker ut vad man än gör såvida barnet inte har astma.

Artikeln i Läkartidningen "Äntligen en effektiv hostmedicin: honung".

Honey May Effectively Treat Cough in Childhood Upper Respiratory Tract Infections

December 3, 2007 - Honey may be a viable option for treating cough associated with upper respiratory tract infections (URIs) in children, according to the results of a randomized study reported in the December 3 issue of the Archives of Pediatrics & Adolescent Medicine.

"Parents of children over age 1 year seeking to relieve the cough and sleep difficulty associated with colds should consider trying honey," lead author Ian M. Paul, MD, MSc, an associate professor of pediatrics and public health sciences at the College of Medicine, Pennsylvania State University, Hershey, tells Medscape Pediatrics. "Honey has been cited by the World Health Organization as a treatment for cough and cold symptoms in children, and it is used for symptomatic relief for these illnesses by cultures all over the world. Because none of the currently available over-the-counter therapies have been shown to be effective for cough and cold symptoms in children, honey was a logical choice to study given that it is safe for children over age 1, cheap, and widely used."

The goal of this partially double-blinded, randomized study was to compare parental satisfaction with the effects of a single nocturnal dose of buckwheat honey, honey-flavored dextromethorphan (DM), or no treatment on nocturnal cough and sleep difficulty in children with URIs.

"Dr. Paul's study represents a welcome addition to the literature on cough medications in children," Michael Dale Warren, MD, from Vanderbilt University in Nashville, Tennessee, told Medscape Pediatrics when asked for independent comment. "During the cough and cold season, pediatricians are bombarded with questions from parents who want to know what they can to do to relieve symptoms in their child who has a cold. Supportive care (nasal saline sprays/drops, bulb suctioning, cool mist humidifiers, fever-reducing medications, fluids, and rest) is the mainstay of therapy for children with URI symptoms."

Dr. Warren, who was not directly involved in this study but was lead author of an accompanying review, is a clinical fellow, Division of General Pediatrics, and instructor in clinical pediatrics at Monroe Carell, Jr. Children's Hospital at Vanderbilt.

"Dr. Paul's study has now shown that honey may be effective in reducing cough symptoms in children with URIs," Dr. Warren said. "Pediatricians who choose to offer therapy to children with cough now have another tool in their arsenal for treating cough symptoms associated with URIs in children."

At a single outpatient, general pediatric practice, 105 children with URIs were randomized to receive a single dose of honey, honey-flavored DM, or no treatment 30 minutes before bedtime. Inclusion criteria were age 2 to 18 years with URI, nocturnal symptoms, and duration of illness of 7 days or less.

Parents completed a survey on 2 consecutive days, first on the day that the child was first seen, when no medication had been given the evening before, and again on the following day after receipt of honey, honey-flavored DM, or no treatment before bedtime. The main endpoints were frequency and severity of cough, bothersome nature of cough, and quality of sleep for child and parent.

"This is a well-designed, randomized controlled clinical trial," Dr. Warren said. "Dr. Paul's study provides valuable information on a topic for which data is lacking - efficacy of cough medicine in children. The authors were diligent in their equal treatment of study groups and in their attempts to maintain blinding between the dextromethorphan and honey groups."

Symptom improvement was significantly different between treatment groups, being consistently scored the best for honey and scored the worst for no treatment. Paired comparisons revealed that honey was significantly better than no treatment for cough frequency and for the combined score, that DM was not better than no treatment for any outcome, and that outcomes for honey and DM were not significantly different.

"The study answers an important question for pediatric providers and for parents - what else can be done to alleviate cough symptoms in children with URIs?" Dr. Warren said. "There is a lack of data supporting many commonly used cough medications in children, yet there is data showing the potential for harm associated with these medications. This question is even more timely given the recent FDA [Food and Drug Administration] panel recommendations that over-the-counter cough and cold medications not be used in children under the age of 6."

Based on this comparison of honey, DM, and no treatment, the study authors concluded that parents rated honey most favorably for symptomatic relief of their child's nocturnal cough and sleep difficulty from URI, suggesting that honey may be the preferred treatment option for the cough and sleep difficulty associated with URI in children. While awaiting additional studies to confirm these findings, they recommend that each clinician consider the positive findings with honey, the absence of such published findings for DM, and the risk for adverse effects and cumulative costs associated with the use of DM.

"The study results are widely applicable to many patients that we see regularly; visits for URIs account for 11% of visits in children ages 1-12, according to the 2005 National Ambulatory Medical Care Survey," Dr. Warren said. "Honey is a reasonable option for treating cough associated with URIs, given its low cost, relatively low adverse effect profile, and potential benefit."

Limitations of the study that the authors acknowledged include the fact that each child had a clinician visit between the 2 nights of the study, which could account for some of the symptomatic relief in all of the groups; some of that relief attributed to the natural history of URIs; use of a subjective survey; and inability to guarantee compliance with medication administration. Dr. Warren also notes that it would be helpful to have more information about the cough scale used for assessing symptoms in this study, and its validation in a full publication.

"It is unclear whether the benefits of honey are variety specific," Dr. Warren continued. "This study used buckwheat honey; the authors note that darker honeys, such as buckwheat honey, consist of more phenolic compounds than other varieties and that the associated antioxidant effect might have contributed to the improvement seen in those children treated with this kind of honey. If the effect is variety specific, then local availability of particular varieties of honey or cost to consumers may limit the applicability of the results."

Dr. Paul told Medscape Pediatrics that additional research should include confirmatory trials of these findings, trials with different types of honey, and determination of the effects of repeated doses. Dr. Warren recommended further studies to develop more pediatric-specific cough symptom questionnaires, to evaluate whether the observed symptomatic relief is specific to particular varieties of honey, and to explore whether similar relief is seen for symptoms other than cough and whether the effects carry over to adults.

"Dr. Paul's work specifically looks at the impact of honey on cough in children," Dr. Warren said. "More research would be needed to determine whether honey is effective in reducing other URI symptoms in children and adults."

However, Dr. Paul believes that the use of honey might be a reasonable therapeutic option beyond the confines of this study.

"I believe the findings would be applicable to adults," Dr. Paul concluded. "As for other symptoms, I suspect honey would also provide relief for throat discomfort."

The National Honey Board, an industry-funded agency of the US Department of Agriculture, supported this study. Dr. Paul has been a consultant to the Consumer Healthcare Products Association and McNeil Consumer Healthcare and has obtained funding. The other study authors have disclosed no relevant financial relationships. Dr. Warren and coauthors have disclosed no relevant financial relationships.

Arch Pediatr Adolesc Med. 2007;161:1140-1146, 1149-1153.

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