Jan. 13, 2009 -- Misuse of Vicks VapoRub may have landed an 18-month-old girl in the hospital, Wake Forest University researchers suggest.
The previously healthy girl had an upper respiratory infection, for which her grandparents treated her with a dab of Vicks VapoRub under the nose. In about half an hour, the child began to struggle for breath, and she was taken to the emergency room.
Bruce K. Rubin, MD, professor of pediatrics at Wake Forest's Brenner Children's Hospital, suggests the grandparents' misuse of Vicks VapoRub may very well have caused the girl's respiratory distress.
"It was summertime, and this child had a virus, but she was disproportionately sick and was not getting better despite treatment [with rescue inhaler and steroids]," Rubin tells WebMD. "Juan Carlos Abanses, MD, was the resident in the emergency room and he went back to the grandparents and asked if there was anything that could have caused this. They said she was doing well until they put a little Vicks under her nose, and pretty soon after she had trouble breathing."
Abanses called Rubin, a lung specialist. Rubin had never heard of Vicks VapoRub causing such a problem, but he knew the product was labeled for use only in children older than 2 years -- and that the product should never be applied to the nostrils.
Rubin told Abanses to stop treatment, as the effects of a local irritant such as Vicks VapoRub should wear off. Sure enough, supplemental oxygen was all the girl needed to get better. She was released from the hospital the next day.
"I think this girl was exquisitely sensitive to Vicks," Rubin says. "In some people Vicks VapoRub causes a rash. This was a girl who was sensitive to Vicks, and had a virus, and inhaled the Vicks and it tipped her over."
That was three years ago. Since then, Rubin says, he and his colleagues have seen three other young children with upper respiratory infections and unusually severe breathing trouble -- and whose parents had inappropriately treated them with Vicks VapoRub. All recovered.
Vicks VapoRub Studies
To find out whether Vicks VapoRub might possibly harm airways, Rubin and colleagues performed a series of experiments on ferrets, whose airway anatomy and biology resemble that of humans. The experiments suggested that Vicks VapoRub could possibly act as an irritant causing mucus to block airways.
How convincing are the studies? WebMD asked Daniel Craven, MD, a pediatric lung specialist at University Hospitals Case Medical Centers Rainbow Babies and Children's Hospital, Cleveland.
"Dr. Rubin is an established expert in this field, and what they found lends support to looking at this further," Craven tells WebMD. "By itself, though, this finding isn't very concerning. If there are harmful effects from Vicks VapoRub, they probably are mild and only seen in certain situations with intense exposure of the airways under conditions where the airways are already compromised."
WebMD also sought the opinion of Ian M. Paul, MD, director of pediatric clinical research at Penn State University. Paul is an expert in over-the-counter cough and cold medicines and is conducting a study of Vicks VapoRub under an unrestricted grant from Procter & Gamble.
"I am on record as being highly critical of cough and cold medicines ... but the [Rubin] case report is "at best incomplete and at worst irresponsible," Paul tells WebMD. "Those symptoms they present are much more likely to be caused by RSV [respiratory syncytial virus]. This child had the classic symptoms of RSV bronchiolitis."
David Bernens, a spokesman for Vicks VapoRub maker Procter & Gamble, says the company receives about three adverse-event reports -- mostly involving skin irritation -- for every million units of Vicks VapoRub sold.
"We take any kind of safety concern very seriously," Bernens tells WebMD. "We have multiple clinical studies, with more than a thousand children age 1 month to 12 years old, that have demonstrated both the safety and efficacy of the Vicks VapoRub product. So we have come to different conclusions than Dr. Rubin."
Risks vs. Benefits
Is any risk from Vicks VapoRub worth the product's benefit? Rubin and Craven point to studies that suggest the active ingredients of the product do not improve air flow in people with nasal congestion. But there is a benefit, Rubin says.
"Vicks is not bad. It does what it is meant to do: It gives the brain the sensation of relief of stuffiness," he says. "Menthol triggers specific cold receptors in the nose and bronchial tubes. That is why it has been added to cigarettes called things like Kool. If you can't sleep because you are so congested, and put it on your chest, it makes you feel better. It doesn't open things up -- but for most kids, it doesn't plug things up, either."
Paul says the reason he's studying Vick's VapoRub is that there's little publicly available scientific data on how well it works for kids with colds or bronchitis. While Procter & Gamble is funding the study, Paul insists that the grant is unrestricted, and that he will publish the results within two years even if they show the product has no efficacy.
Craven notes that Vicks VapoRub has been around for more than a century and reports of adverse events remain few.
"This product has been used for years and years and years and there have not been a lot of reports of it causing problems," he says. "That lowers the chances that it could cause respiratory failure. But the Rubin study does show some things that merit further investigation to see if we should be more careful in cautioning people against using it in some circumstances."
Meanwhile, everyone who spoke with WebMD urges parents to use Vicks VapoRub only as directed: on children older than 2 years, and applied only to the chest, back, or throat and NOT to the nostrils or on wounds or open skin.
The Rubin study appears in the January issue of the journal Chest.