No differences in respiratory tract infection treatments

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1. Study found no significant differences in treatment outcomes between ibuprofen, paracetamol, combinations of the therapies, and steam inhalation in treating symptoms associated with respiratory tract infections.

2. Data from this study contradicts an earlier Cochrane review study which showed steam inhalation to provide a marginal benefit to patients with respiratory tract infections.

Evidence Rating Level: 2 (Good) 

Study Rundown: This study compared the pragmatic efficacy of independent analgesics and antipyretics (paracetamol & ibuprofen), combinations of these treatments, as well as steam inhalation in treating symptoms associated with respiratory tract infections. The study randomized treatments for patients (n=889) and measured symptom severity on a scale of 0 (no problem) to 7 (as bad as it can be) after two to four days of treatment. Researchers found that there was little to no significant difference in treatment outcomes between the various therapies, except among patients with pre-existent chest infection. This subgroup of patients reported slightly better symptom management with ibuprofen rather than paracetamol. Studies investigating symptom severity can often be viewed with varying confidence based on the subjective nature of the data, however this study also used temperature and return visits as secondary measures which confirmed the results of the symptom severity. Furthermore, evidence in this study showing no significant differences in positive outcomes associated with steam inhalation contradict earlier research from a Cochrane review study.

Click to read the study in British Medical Journal

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In-Depth [randomized factorial trial]: Over 52 general practitioners across the UK took part in this study from March 2010 to March 2012. No significant differences were identified in this comparative study, except among patients who were also dealing with chest infections who were treated with ibuprofen (-0.40, 95% CI: -0.78 to -0.01). As secondary measures, researchers evaluated the rate of follow-up visits to determine the effectiveness of the treatment and found 12% of patients treated with paracetamol returned compared with 20% of patients treated with ibuprofen, and 17% treated with a combination. Lastly, there were four patients identified who experienced a mild burn injury from steam inhalation. This last piece of data prompted the researchers to advise practitioners not to promote the practice of direct steam inhalation over boiling water for symptom relief.

By Jordan Anderson and Andrew Bishara

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