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Correspondence |

Vicks VapoRub Study: Incomplete Case Report and Misleading Publicity FREE TO VIEW

Ian M. Paul, MD, MSc
Author and Funding Information

Penn State College of Medicine Hershey, PA

Ian M. Paul, MD, MSc, Penn State College of Medicine, Department of Pediatrics, HS83, 500 University Dr, Hershey, PA 17033; e-mail: ipaul@psu.edu


Dr. Paul serves as a consultant for Procter & Gamble Company and has an unrestricted research grant from them.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):650. doi:10.1378/chest.09-0324
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Published online

To the Editor:

Because upper respiratory tract infections (URTIs) are self-limited, the medications used to treat them must be safe and effective. Coinciding with media reports, I read the publication regarding Vicks VapoRub (VVR).1 As a pediatrician conducting trials on cough and cold medicines for children, I have criticized the limited evidence for these products. However, I found the current publication and press release2 incomplete and misleading with exaggerated or inaccurate statements.

First, I was disappointed by the case report's missing data. Given the child's age, the presence of cold symptoms, the concern for an asthma exacerbation, the lack of effect of albuterol and prednisolone, and the improvement of the child's condition with oxygen therapy, it is unclear why bronchiolitis was not entertained as a diagnosis. Respiratory syncytial virus, influenza, and other viral test results are absent. Since bronchiolitis commonly causes asthma-like respiratory distress and because adverse events with the use of VVR are exceedingly rare, the omission of this information limits one's ability to determine causality. While the distress was reportedly of rapid onset, this was based on a subjective medical history from grandparents who did not follow label instructions.3 This case report must be compared with extensive safety data demonstrating that in the past 5 years > 1 billion units have been sold with fewer than three adverse events reported per million units sold (Procter and Gamble Company; personal communication; January 12, 2009).

Next, beyond obvious differences between an 18-month old child with a URTI who had VVR applied to nostrils and (1) excised ferret tracheas bathed in high concentrations of VVR and (2) intubated adult ferrets with medication applied to the endotracheal tube, the study title and conclusions do not match the results. Particularly for the in vivo studies, there was no significant increase in mucin production over baseline nor were there significant changes to mucociliary transport velocity (except in the lipopolysaccharide model) and lung water. However, in the summary statement in the article, the authors wrote that VVR leads to “increasing mucus secretion while decreasing mucus clearance,” but prior to this they had admitted their findings are not statistically significant. Therefore, the statement is not supported by in vivo data. The statement and manuscript title can therefore be considered misleading.

Last, regarding the statement that “fooling the brain into perceiving increased airflow,” achieving symptomatic relief of pain with nonsteroidal antiinflammatory drugs or opiates could also be characterized as “fooling the brain.” As with analgesia, most individuals welcome subjective symptom relief from URTIs. To that end and to report safety and efficacy evidence in children, we are conducting a trial on the effectiveness of VVR in children with URTIs that is being funded through an unrestricted grant from Procter and Gamble.

Abanses JC, Arima S, Rubin BK. Vicks VapoRub induces mucin secretion, decreases ciliary beat frequency, and increases tracheal mucus transport in the ferret trachea. Chest. 2009;135:143-148. [PubMed] [CrossRef]
 
American College of Chest Physicians Misuse of Vicks VapoRub may harm infants and toddlers: toddler in respiratory distress after popular salve used.Accessed January 26, 2009 Available at:http://www.chestnet.org/about/press/releases/2009/090113.php.
 
Procter & Gamble Vicks VapoRub.Accessed January 26, 2009 Available at:http://www.vicks.com/products/vaporub.
 

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References

Abanses JC, Arima S, Rubin BK. Vicks VapoRub induces mucin secretion, decreases ciliary beat frequency, and increases tracheal mucus transport in the ferret trachea. Chest. 2009;135:143-148. [PubMed] [CrossRef]
 
American College of Chest Physicians Misuse of Vicks VapoRub may harm infants and toddlers: toddler in respiratory distress after popular salve used.Accessed January 26, 2009 Available at:http://www.chestnet.org/about/press/releases/2009/090113.php.
 
Procter & Gamble Vicks VapoRub.Accessed January 26, 2009 Available at:http://www.vicks.com/products/vaporub.
 
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