cough drop
| Dictionary: cough drop |
n.
A small, often medicated and sweetened lozenge taken orally to ease coughing or soothe a sore throat.
| 5min Related Video: cough drop |
| How Products are Made: How is a cough drop made? |
A cough drop is medicinal tablet designed to deliver active ingredients which suppress or relieve the cough reflex. They are made just like hard candies; ingredients are mixed together, they are cooked, cooled, and packaged. First developed during the eighteenth century, cough drops have become a significant part of the $2 billion cough and cold market.
Background
Anyone who has gotten sick knows the sensation of a cough. It is a natural reflex that helps protect the body from infections. It plays an important role in clearing the throat and other air passages of secretions and irritating particles. These particles include dust, food, liquids, and mucus. A cough occurs in three distinct steps. It typically begins with a deep breath which draws air into the lungs. The vocal cords spontaneously close thereby sealing the windpipe. Next, the air is compressed by the tightening of the expiratory muscles. The vocal cords are suddenly opened and the air trapped in the lungs is rapidly expelled along with any foreign debris in the windpipe.
Coughs associated with colds can be either productive or nonproductive. A productive cough helps clear the respiratory passages of the lung. A nonproductive cough is brought on by a minor irritation and has a limited benefit. It is the nonproductive cough that cough drops are designed to sooth or suppress.
The are two types of active ingredients in a nonprescription cough drop including expectorants and cough suppressants. An expectorant is a material that aids in the removal of phlegm from the respiratory tract. It works by blocking the sensory nerves that are involved in triggering a cough. While many expectorants are available, data about their functionality is not. Some clinicians even question whether expectorants are effective. Antitussives, which are cough suppressants, work in a variety of ways affecting either the lungs, muscles, or brain.
History
Using syrups and herbal teas to control coughing has been known since antiquity. An ancient Hebrew text suggests the use of goat's milk for this reason. In the second century, Galen was perhaps the first to report an effective cough suppressant. Cough drops originally developed from candy. The first hard candies were produced during the fourth century. Since sugar was so expensive, these products were typically a luxury item available only to the rich. Over the years, sugar crops were planted in North America and throughout the world. Sugar refiners were established, and the price of sugar was reduced, making it available to everyone by the eighteenth century.
While the active ingredients in a cough drop were known for centuries, it was not until the nineteenth century that the cough drop was born. One of the first mass-produced cough drops was the Smith Brothers cough drop. According to the company, James Smith was operating a restaurant when a journeyman introduced him to a formula for a cough candy. He mixed up a batch in his kitchen and was able to quickly sell them. Demand for his product grew and he began advertising in 1852. He enlisted the aid of his two sons who helped mix batches and sell them on the streets of Poughkeepsie, New York. They inherited the business in 1866 when James Smith died, and renamed the company Smith Brothers. During this time, they sold their cough drops in large glass bowls. To prevent imitators, they developed a unique package in 1872 that was filled at the factory. In 1922, menthol cough drops were introduced. Over the years, a variety of manufacturers have developed their own cough drop formulas. Each one has tried to improve the flavor and efficacy of their product.
Raw Materials
Cough drops have two categories of ingredients. One type makes up most of the cough drop while the other is the active, or functional, ingredients. The major portion of cough drops is made up of ingredients found in typical hard candy recipes. The essential ingredients include sugar, corn syrup, acids, colors, and flavors. Sugar is a disaccharide compound called sucrose. It is obtained primarily from sugarcane or sugar beets by an extraction process. In a cough drop recipe, sugar crystals are usually used. Sugar is responsible for the physical structure of the cough drop along with its sweet taste and mouthfeel.
Corn syrup is a main component of cough drops. It is a mixture of sugars that is composed of polysaccharides, dextrose, and maltose. The main reason it is used is to control the crystallization of sugar. It also provides some sweetness and body to the cough drop. Additionally, it reduces the formation of dust from sugar during the blending stage.
To increase the visual appeal of the cough drop various dyes are added. In the United States, these dyes are strictly regulated by the government. Some that are allowed in food products include red dye #40, yellow dye #5, yellow dye #6, and blue dye #1. Natural colorants like caramel coloring are also used. Using only these colorants, the most popular cough drop colors, red and blue, can be produced.
To cover the taste of the active ingredients, various flavoring ingredients are put into cough drop recipes. Both artificial and natural flavors are used. Artificial flavors are mixtures of aromatic chemicals like methyl anthranilate and ethyl caporate. Natural flavors are derived from fruits, berries, and honey. Acids such as citric, lactic, tartaric, and malic acid are also included to modify the flavor.
Various active ingredients can be included in a cough drop recipe. As mentioned previously, these can be either expectorants or antitussives. Some common ingredients are volatile oils such as menthol or eucalyptus oil. Volatile oils, or essential oils, are obtained from parts of a plant through extraction or distillation processes. Menthol is typically isolated from the Mentha arvensis plant or distilled from peppermint oil. It may also be synthetically produced. Menthol has a cooling effect in the mouth that helps to relieve irritation. It is also thought to work as an expectorant. Eucalyptus oil is isolated from the eucalyptus plant. It is believed to have a medicinal effect functioning as an expectorant and a relief agent for minor mouth and throat irritations. Recently, companies have been including zinc in their cough drops. Certain evidence suggests that zinc may be beneficial in fighting symptoms of a cold. Vitamin C is another ingredient that has been included in some brands of cough drops. Other ingredients that may be found are herbals such as echinacea or ginko biloba. Peppermint oil, camphor, and sodium citrate have also been used.
Design
Cough drops, or lozenges, are usually sold as small, hard candy pieces that slowly release their medicine as they melt in the mouth. Chemically speaking, they are a supersaturated solution of water molecules, sugar, and corn syrup. They can be either grained (opaque) or nongrained (clear). While all cough drops are designed to sooth and relieve coughing, some have added ingredients to help fight colds, freshen breath, or clear nasal congestion. Certain cough drops have reduced active ingredients and are created specifically for children. There are a wide variety of flavors, the most popular of which are cherry, honey, and menthol.
The Manufacturing
Process
The basic steps in producing a cough drop are mixing, cooking, cooling-working, forming, cooling, and packaging. Most manufacturers have an automated production line connected by a conveyor system.
Mixing
- In this manufacturing step, the ingredients are combined in a large, stainless steel container by compounding personnel. Water is usually pumped directly in to the tank. The sugar, corn syrup, and certain other ingredients are then mixed until they are ready to be cooked.
Cooking
- To produce the cough drop, the moisture level of the mixture must be reduced. Some cough drops have a moisture content as low as 0.5%. There are three types of cookers that are employed. Batch cooking involves a direct-fire cooker. In this method, the heat is applied to the mixture from below and the moisture evaporates into the air. Quicker methods use either a semicontinuous cooker or a continuous cooker that operates under low pressure conditions. In the semicontinuous process, the cough drop mixture is first boiled under atmospheric pressure and then pumped into a second kettle that is a vacuum chamber. It is then rapidly cooked and drawn off for working. Continuous cookers use a scraped-surface heat-exchanger which can cook the cough drop within a few seconds.
Cooling and working
- After cooking, the cough drop mixture is conveyored to cooling slabs. It is cooled to facilitate incorporation of ingredients such as color, flavors, and active ingredients. The cooling slabs are composed of steel and have a built-in circulating water system. Candy plows are also involved. They move the mixture around so some of the hotter areas come in contact with the cooler surface of the slabs. As it cools, the mixture becomes plasticized and it looks like a workable mass similar to dough.
- At this point, the rest of the cough drop ingredients are added. They are poured onto the batch and machines pull and twist the mass, working the ingredients throughout. When everything is adequately combined, the batch is split off and sent through a sizing machine. These devices roll the batch into a cylindrically shaped mass and reduce the diameter to a suitable size. From here, the mass is fed into the forming machines.
Forming
- Various forming machines are available. Typically, cough drops are tablet-shaped products. The cylindrical mass runs through this machine and is cut into smaller pieces. These pieces are then put into a die and stamped to produce the desired shape. The cough drops are then ejected from the die and moved to the finishing phases of production.
Cooling and packaging
- The formed cough drops are rapidly cooled to ensure that they maintain their shape. This is done on a conveyor belt that is equipped with rapidly blowing air jets. From the cooling area, the cough drops are put into packaging. Many manufacturers wrap each cough drop in a wax paper package to prevent them from absorbing moisture from the air. A number of these are then put into a larger bag for final sales. Other manufacturers do not individually wrap their cough drops, but store them in a bulk package. These are typically a wax-coated box that is sealed. To prevent them from sticking together, bulk packaged cough drops are often coated.
Quality Control
As with all food and drug processing facilities, quality control begins by monitoring the characteristics of the incoming ingredients. These ingredients are taken to a quality control lab where they are tested to ensure they meet specifications. Tests include evaluation of the ingredient's physical properties such as appearance, color, odor, and flavor. Certain chemical properties of the ingredients may also be evaluated. Each manufacturer has their own tests that help certify that the incoming ingredients will produce a consistent cough drop. In addition to ingredient checks, the packaging is also inspected to ensure it meets the set specifications.
After production, the characteristics of the final product such as appearance, flavor, texture, and odor are also carefully monitored. The usual test methods involve comparing the final product to an established standard. For example, to make sure the flavor is correct, a random sample may be taken and compared to some set standard. Other qualities such as appearance, texture, and odor may be evaluated by sensory panels, a group of specialists that are trained to determine small differences. In addition to sensory tests, other instrumental measurements are taken.
The Future
Cough drop recipes have changed little since they were first introduced. Most of the advancements have come in the design of the cookers and other processing equipment. It is expected that future improvements aimed at increasing the speed of production will continue to be found. Another area that will be expanded will be the addition of novel ingredients that may provide multiple benefits to the consumer. For example, some cough drop marketers have introduced vitamin C-containing products. These cough drops are intended not only to sooth a cough, but also relieve some of the symptoms of a cold.
Where to Learn More
Books
Alikonis, J. Candy Technology. Westport, CT: AVI Publishing Co., 1979.
Covington, T. Handbook of Nonprescription Drugs. Washington, DC: American Pharmaceutical Association, 1993.
Mathlouthi, M. and P. Reiser, eds. Sucrose: Properties and Applications. London: Blackie and Sons, Ltd., 1995.
Periodicals
Friedman, M. "As Temperatures Drop, Cough Remedies Flourish." Adweek (February, 1989).
Slezak, M. "Warm Weather Cools Cough and Cold Sales." Supermarket News (March 6, 1995).
[Article by: Perry Romanowski]
| Medical Dictionary: cough drop |
n.
A small, often medicated and sweetened lozenge taken orally to ease coughing or soothe a sore throat.
| WordNet: cough drop |
Note: click on a word meaning below to see its connections and related words.
The noun has one meaning:
Meaning #1:
a medicated lozenge used to soothe the throat
Synonyms: troche, pastille, pastil
| Wikipedia: Cough medicine |
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A cough medicine or linctus when in syrup form is a medicinal drug used in an attempt to treat coughing and related conditions. For dry coughs treatments with cough suppressants (antitussives) may be attempted to suppress the body's urge to cough, while productive coughs (coughs that produce phlegm) treatment is attempted with expectorants that loosen mucus from the respiratory tract.
Even though they are used by 10% of American children weekly they are not recommended in children 6 years of age and under due to lack of evidence showing effect and concerns of harm.[1] [2]
Contents |
Examples
Pharmaceuticals
- Dextromethorphan
Dextromethorphan (DM) may be modestly effective in decreasing cough in adults with viral upper respiratory infections. In children however it has not been found to be effective.[3]
- Codeine
Codeine is claimed to be one of the strongest cough suppressants. Evidence to support this is however weak with a recent placebo controlled trial finding that codeine was no better than placebo.[4]
- Others
Other commercially available treatments have not been shown to be effective in viral upper respirtory infections including in adults: antihistamines, antihistamine-decongestant combinations, and guaifenesin and in children antihistamines, decongestants, DM, or combinations of them[5]
No over the counter cough medicine has not been found to be effective in pneumonia.[6]
Alternative medicine
Honey may be an effective treatment of cough. Buckwheat honey given before bedtime provided better cough relief at night and improved sleep difficulty in children more than no treatment or dextromethorphan.[7]
Many alternative treatments are used to treat the common cold. None however are recommended due to the insufficient solid scientific evidence.[8][9]
A 2009 review found that the evidence supporting the effectiveness of zinc is mixed with respect to cough[10] and a 2000 Cochrane review found the evidence of benefit or harm in the common cold inconclusive.[11] A 2004 review however found a possible decrease in the severity and incidence of the common cold in certain sub populations.[12]
A 2006 Cochrane review of echinacea found that in trials for prevention of the common cold it was ineffective (3) well for treatment an effect was seen in some trials (9) and no effect is seen in others (6).[13] A review in 2007 found an overall benefit from echinacea for the common cold[14] however further analysis found problems with the interpretations of this review.[15]
While a number of plants and Chinese herbs have been purported to ease cold symptoms, including ginger, garlic, hyssop, mullein, and others, scientific studies have either not been done or have been found inconclusive.[16]
Effectiveness
In 2001, researchers at the University of Bristol (Schroeder & Fahey) published the results of their meta analysis in the British Medical Journal indicating that some cough medicines may be no more effective than placebos for acute coughs in adults, including coughs related to upper respiratory tract infections.[17] In 2006, the American College of Chest Physicians published a guideline that had the dual message that many over-the-counter cough medicines are not effective and that those that are effective in treating the symptom do not treat the underlying cause; the underlying disorder emphasized by the guideline was pertussis (whooping cough) in the elderly.[18].
The Cochrane Collaboration, an international organization that evaluates medical research, reviewed 25 studies, 17 of which involved 2,876 adults and eight of which involved 616 children. In the adult studies, six compared antitussives medicines used to relieve coughs with placebo and had variable results. Two studies compared an expectorant with placebo; one found benefits. Another two studies focusing on combinations of antihistamine and decongestants produced conflicting results, while three studies found antihistamines were no more effective than placebo in relieving cough. Three other adult studies compared combinations of drugs with placebo and showed some benefit in reducing cough; one study found that mucolytics, which break down mucus, reduced cough frequency. In studies involving children, seven — two with antitussives, two with antihistamines, two with antihistamine decongestants and one with antitussive-bronchodilator combinations — showed the drugs were no more effective than placebo. One trial tested two pediatric cough syrups and both preparations showed a ’satisfactory response’ in 46% and 56% of children compared to 21% of children in the placebo group. [19]
The efficacy of cough syrups for children has long been questioned by medical professionals. A report in pharmaceutical journal Australian Prescriber found that although tests results for efficacy were inconclusive for children over 2 years of age, a number of factors including accidental overdoses and well-documented adverse effects suggested caution in the paedriatic prescription of cough syrups and medicines[20].The report also noted that efficacy in children under two years was extremely limited and strongly recommended against prescription to this group based on the aforementioned health risks.
Recent studies have found that theobromine, a compound found in cacao, is more effective as a cough suppressant than prescription codeine. This compound suppresses the "itch" signal from the nerve in the back of the throat that causes the cough reflex. It is possible to get an effective dose (1 g, though 0.5 g may be sufficient)[21] from 50g of dark chocolate, which contains 2 to 10 times more cacao than milk chocolate. Cocoa powder contains roughly 0.1 g per tablespoon (5g).[22] Theobromine was also free from side effects in the blind tests.[23]
Mass poisonings due to diethylene glycol
Main article: Toxic cough syrup
According to the New York Times, at least eight mass poisonings have occurred as a result of counterfeit cough syrup, substituting inexpensive diethylene glycol in place of glycerin. In May 2007, 365 deaths were reported in Panama, which were associated with cough syrup containing diethylene glycol.[24]
See also
References
- ^ "Use of over-the-counter cough and cold medications in children -- Shefrin and Goldman 55 (11): 1081 -- Canadian Family Physician". http://www.cfp.ca/cgi/content/full/55/11/1081.
- ^ http://www.cnn.com/2007/HEALTH/10/19/coldmed.fda/index.html
- ^ Dealleaume L, Tweed B, Neher JO (October 2009). "Do OTC remedies relieve cough in acute upper respiratory infections?". J Fam Pract 58 (10): 559a–c. PMID 19874728.
- ^ "journals.lww.com". http://journals.lww.com/co-allergy/Abstract/2007/02000/Codeine_and_cough__an_ineffective_gold_standard.7.aspx.
- ^ Dealleaume L, Tweed B, Neher JO (October 2009). "Do OTC remedies relieve cough in acute upper respiratory infections?". J Fam Pract 58 (10): 559a–c. PMID 19874728.
- ^ Chang CC, Cheng AC, Chang AB (2007). "Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults". Cochrane Database Syst Rev (4): CD006088. doi:. PMID 17943884.
- ^ http://www.sciencedaily.com/releases/2007/12/071203164750.htm
- ^ "A Survival Guide for Preventing and Treating Influenza and the Common Cold". American Lung Association. August 2005. http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35873#done. Retrieved 11 June 2007.
- ^ Simasek M, Blandino DA (February 2007). "Treatment of the common cold". Am Fam Physician 75 (4): 515–20. PMID 17323712.
- ^ Dealleaume L, Tweed B, Neher JO (October 2009). "Do OTC remedies relieve cough in acute upper respiratory infections?". J Fam Pract 58 (10): 559a–c. PMID 19874728.
- ^ Marshall I (2000). "Zinc for the common cold". Cochrane Database Syst Rev (2): CD001364. doi:. PMID 10796643.
- ^ Hulisz D (2004). "Efficacy of zinc against common cold viruses: an overview". J Am Pharm Assoc (2003) 44 (5): 594–603. PMID 15496046.
- ^ Linde K, Barrett B, Wölkart K, Bauer R, Melchart D (2006). "Echinacea for preventing and treating the common cold". Cochrane Database Syst Rev (1): CD000530. doi:. PMID 16437427.
- ^ Shah SA, Sander S, White CM, Rinaldi M, Coleman CI (July 2007). "Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis". Lancet Infect Dis 7 (7): 473–80. doi:. PMID 17597571.
- ^ von Maxen A, Schoenhoefer PS (June 2008). "Benefit of echinacea for the prevention and treatment of the common cold?". Lancet Infect Dis 8 (6): 346–7; author reply 347–8. doi:. PMID 18501849.
- ^ Linde K, Barrett B, Wölkart K, Bauer R, Melchart D (2006). "Echinacea for preventing and treating the common cold". Cochrane Database Syst Rev (1): CD000530. doi:. PMID 16437427.
- ^ Knut Schroeder and Tom Fahey (2002). "Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults". British Medical Journal 324: 329–331. doi:. PMID 11834560. http://bmj.bmjjournals.com/cgi/content/full/324/7333/329.
- ^ American College of Chest Physicians (January 9, 2006). "New Cough Guidelines Urge Adult Whooping Cough Vaccine; Many OTC Medications Not Recommended for Cough Treatment". Press release. http://www.chestnet.org/about/press/releases/2006/010906a.php.
- ^ Over-the-counter medications for acute cough in children and adults in ambulatory settings (Review) 1 http://www.cfah.org/hbns/archives/viewSupportDoc.cfm?supportingDocID=524
- ^ Sung, Valerie and Cranswick, Noel (2009). "Cough and cold remedies for children". Australian Prescriber, Vol. 32.pp 122-124. Available at http://www.australianprescriber.com/upload/pdf/articles/1047.pdf.
- ^ Usmani OS, Belvisi MG, Patel HJ, et al. (February 2005). "Theobromine inhibits sensory nerve activation and cough". The FASEB journal: official publication of the Federation of American Societies for Experimental Biology 19 (2): 231–3. doi:. PMID 15548587. http://www.fasebj.org/cgi/pmidlookup?view=long&pmid=15548587.
- ^ Chocolate Products - Nutritional Information - HERSHEY'S
- ^ Vince, Gaia (November 22, 2004). "Persistent coughs melt away with chocolate". New Scientist. http://www.newscientist.com/article.ns?id=dn6699.
- ^ From China to Panama, a Trail of Poisoned Medicine - New York Times
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- Panni Sporchi (1999 Comedy Film)
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