Inhalation claim appears to be losing steam

The age-old remedy for cold and cough — steam inhalation — may not be as effective for children as thought. According to a new research, it only makes a patient feel better but does not necessarily improve his/her condition.

The research published in Indian Academy of Pediatrics journal Indian Pediatrics did not find enough evidence supporting benefit of steam inhalation in acute (upper and lower) respiratory tract infections in children.

Upper tract infections result in common cold, croup and sore throat, while lower tract infections cause bronchiolitis, pneumonia, etc.

After examining this age-old remedy’s relevance in modern evidence-based healthcare practices and whether it resulted in clinical improvement in people with respiratory illnesses, Joseph L Mathew of Advanced Pediatrics Centre, PGIMER, Chandigarh, wrote that there was no scientific ground to encourage steam inhalation by children.

“The practice of steam inhalation could have been relatively justifiable at a time when there was limited understanding of pathophysiologic mechanisms in various respiratory tract illnesses, coupled with limited therapeutic options. Both situations have dramatically changed for most respiratory conditions,” he wrote.

Mathew believes that subjective improvement/perception of relief often do not correlate with objective measurements. “This raises the tricky issue of whether feeling better is superior to being better. In the context of conditions as diverse as acute common cold to chronic arthritis, the former cannot be ignored, and may take precedence over precise objective measurements. On the other hand, for most other clinical conditions, demonstration of subjective improvement may be inadequate to prove that an intervention works. The precise balance between subjective and objective outcome measures in common cold is not clear,” he wrote.

So, is there harm in recommending steam inhalation? “Many care-givers [physicians and parents] may favour steam inhalation based on personal [favourable] experiences, and might argue that this outweighs the [absence of] data from research. It must be emphasised that one of the goals of evidence-based healthcare is to protect patients from precisely this tendency,” Mathew wrote.

However, there are voices of disagreement. “Steam inhalation liquefies dry mucus in the thin nasal passage of children and helps clear it easily, decongesting nose,” Anjali Mathur, neonatal care specialist at Delhi’s Moolchand Hospital, said.