Agave, Placebo Were Better Than Nothing for Cough Treatment

Agave nectar and placebo both improved sleep for infants and toddlers with nighttime cough, parents said

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Because agave is similar to honey, a common cough treatment, the authors of a recent study thought agave might also treat nighttime cough in kids. While agave didn't perform any better than a placebo, both agave and the placebo were better than nothing.

Citing a high desire from parents for effective infant and toddler cough treatments, the researchers set out to examine the effect of agave nectar on nighttime cough.

These researchers found that agave nectar appeared to improve symptoms compared to no treatment, but so did a placebo.

Cough is one of the most common reasons kids visit the doctor, the study authors, led by Ian M. Paul, MD, noted. Infants and toddlers with coughs often have trouble sleeping.

"It is particularly bothersome at night, as evidenced by a recent study of the effect of cough on sleep for infants with colds, which found that cough disturbed the sleep of 88 percent of the children and 72 percent of their parents," the Penn State researchers wrote.

And parents, according to the researchers, want a way to treat cough in their kids. But, the study authors point out, there is little evidence that over-the-counter medicine effectively treats coughs in young children, and the US Food and Drug Administration warns against using these treatments in children younger than 2.

Robert Kotas, MD, a pediatrician at Baylor Medical Center in Garland, TX, told dailyRx News the treatment he most often prescribes for cough in children is education.

"I tell patients that cough is usually a natural reflex that clears the lungs of mucous and debris," he said. "In fact, cough is actually beneficial to keeping a child healthy."

Honey is a common cough treatment around the world, but infants younger than 1 cannot eat honey due to concerns about infant botulism — a potentially deadly disease caused by bacteria that honey may carry.

"Occasionally, I recommend honey for patients over two years of age," Dr. Kotas said. "There have been several studies showing honey to be superior to a placebo in the treatment of cough symptoms."

Because honey has been proven effective in past studies, Dr. Paul and colleagues wanted to test something similar that did not contain botulism-causing bacteria — agave nectar. Agave nectar is the sweet, syrupy nectar of the agave plant.

"We hypothesized that the [soothing] effect of agave nectar would provide relief for cough in children similar to that of honey," the authors wrote.

To test their hypothesis, the study authors gave one dose of agave nectar, a placebo (fake treatment) or nothing to 119 infants and toddlers with coughs 30 minutes before bed time. The kids were between 2 and 47 months old.

Then, the authors surveyed the children's parents to see whether the treatments had improved cough symptoms.

The survey results indicated that both the placebo and agave nectar noticeably improved cough symptoms in the children — but agave nectar was no more beneficial than the placebo. The kids who received no treatment did not show improvement in their cough symptoms or nighttime sleep troubles.

The study authors said the placebo effect — a phenomenon in which patients feel better when they receive a fake treatment they believe to be real — likely caused the children to feel better. They said doctors should consider the sometimes positive effects of knowingly using a placebo in treating young children with symptoms like cough.

The authors of a related editorial about this study said the children in the study weren't likely the ones experiencing the placebo effect because they might have been too young to understand how medical treatment works.

"Rather, what the investigators are observing in this study is a placebo effect in the parents who assessed outcomes in study children using a cough symptom questionnaire," wrote James A. Taylor, MD, and Douglas J. Opel, MD, of the University of Washington in Seattle. They said this "broader characterization of the placebo effect is largely driven by a similar mechanism — the parents' perception that their child received the active treatment."

This study and editorial were published Oct. 27 in JAMA Pediatrics.

A grant from Zarbee's Inc. funded the study. Dr. Paul had served as a paid consultant to Zarbee's but ended the relationship before the study began.

Review Date: 
October 27, 2014
Last Updated:
October 30, 2014