Tuesday, May 16, 2006

Codeine for cough; osteonecrosis of the jaw

The Journal of Allergy and Clinical Immunology has published a trial indicating that codeine is ineffective for COPD related cough.  This was a randomized, double-blind, placebo-controlled cross over trial of 21 people with 'stable' and moderate COPD.  They took 60mg of codeine or placebo--the authors note that this dose of codeine is substantially higher than what's in most cough syrups.  Essentially they found that codeine didn't decrease time spent coughing, frequency of cough, or cough sensitivity (using a laboratory based challenge) compared to placebo.  Both placebo and codeine decreased time coughing a little bit compared to baseline, suggesting that there is a small placebo effect.  Clearly the numbers here are small, and the patients weren't studied long term at all.  Per the authors this is the first RCT of codeine in COPD which itself is depressing.  All of this is reminding me that despite my regular use of antitussives I've never read one shred of evidence to support their use--I just use them as I was trained to use them.  Of course me never having read a shred of evidence is because I've never looked for it, and so perhaps that'll change. 

Anyway, the most interesting aspect of this article is the authors' discussion at the end of how one goes about studying cough.  What is an outcome?  Number of coughs?  If so is a peal of coughs, a fit of coughing, a single coughing event, or is it a dozen individual coughs, etc?

Annals of Internal Medicine this week has a review of jaw osteonecrosis related to bisphosphonates--a rare but increasingly recognized and potentially devastating adverse effect of some of these drugs.  I won't summarize it here, other than to wonder if this is going to become more of a problem as indications for the use of these agents increase.  From the review it appears that prevalence data is not widely available, but some in some myeloma series it looks like it is up to 10% (of patients receiving high dose, long term IV bisphosphonates to prevent skeletal complications of myeloma)--which to me seems like a frighteningly high number.

I am packing up and moving across town this coming week and don't anticipate I'll be blogging much until next week sometime.  That being said, you can still leave comments!!

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