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The venerable nasal congestion remedy Vicks VapoRub beat out petroleum jelly and no treatment for easing nighttime symptoms of upper respiratory tract infections in children, according to a study funded by the product's maker.

In the study of more than 130 children, improvement was found in each group for all study outcomes, but cough, congestion, and sleep were significantly improved more in those children who used VapoRub, Ian Paul, MD, of Penn State College of Medicine in Hershey, Pa., and colleagues reported online ahead of the December issue of Pediatrics.

In addition, parents slept better when their children used VapoRub -- an ointment containing camphor, menthol, and eucalyptus oils.

Parents have been using products like Vicks VapoRub for decades to treat their children's cold symptoms, but there had actually been a lack of evidence to support or refute the practice.

So Paul and his colleagues randomized 138 children ages 2 to 11 to one of three groups for one night -- Vicks VapoRub, petroleum jelly, or no treatment. The three groups were well matched at baseline with an average duration of cough and congestion of about four days.

Parents completed a survey about their child's symptoms before and after a night of treatment.

The researchers attempted to blind the parents in the two ointment groups by having them place Vicks VapoRub under their noses before they applied the treatment to their children and leaving it there until completing the final survey. Even so, 86% of the parents in the VapoRub group and 89% of those in the petroleum jelly group correctly guessed which treatment they were using.

Interestingly, though, cough, congestion, rhinorrhea, and sleep were significantly improved in all three groups.

The researchers noted that this general improvement may have resulted from the physician visit -- which may have eased the parents' minds about the severity of the illness -- or simply from the natural progression of upper respiratory tract infections.

Other limitations of the study included parents in the petroleum jelly group more commonly giving their children acetaminophen and 9% of parents in the no-treatment group admitting that they gave their kids cough and cold medication overnight, despite being told not to do so.

This indicates that some parents have "a strong desire to do something" for upper respiratory infections and "are not content to simply observe their children or provide "supportive care," the authors observed.

In a three-way comparison, Vicks VapoRub resulted in significantly greater improvements on all outcomes except for rhinorrhea (P<0.05 for all) -- and using no treatment at all consistently fared the worst.

In two-way comparisons, Vicks VapoRub was better than no treatment for cough severity and frequency, nasal congestion, and both the child's and parents' sleep (P<0.05 for all). It was also superior to petroleum jelly for the sleep outcomes.

Using plain petroleum jelly, however, fared no better than no treatment for any study outcome.

Adverse effects were common in the Vicks VapoRub group, reported by 46% of parents. Nearly all were the expected effects of irritation affecting the skin, eyes, and nose. None of the children in the other groups reported these side effects.

Paul and his colleagues speculated that the benefits of compounds like Vicks VapoRub seem to be related to effects on the TRPM8 cation channel -- which is activated by menthol and thermal stimuli in the cool to cold range.

"Most likely through this mechanism, menthol has been shown to improve the nasal sensation of airflow in congested adults with upper respiratory tract infections and healthy school-aged children," they wrote.

"Compounds that contain menthol and/or camphor have also been shown to reduce respiratory rate and restlessness in children with acute bronchitis, reduce evoked cough in healthy adults, and improve mucociliary clearance in adults with chronic bronchitis," Paul and co-authors added.

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