Dr. Bruce Rubin, has seen a lot of puzzling cases of respiratory problems. But Rubin, the vice chair of pediatric pulmonology at Wake Forest University Medical Center in Winston-Salem, N.C., said he had never encountered anything quite like the case he saw about three years ago.
An emergency room physician consulted Rubin when an 18-month-old girl who had a common upper respiratory infection suddenly developed severe breathing problems.
"The patient was disproportionately ill for having just an upper respiratory infection," Rubin said.
According to a case report published in the journal Chest by Rubin and his colleagues, the child was recovering relatively well while battling her respiratory infection until about two hours before she was admitted to the emergency room.
When doctors began questioning the patient's grandparents about what might have caused the girl's respiratory distress, the only answer her grandparents could come up with was that they had rubbed Vicks VapoRub under the child's nose earlier that day.
"Sure enough, we demonstrated that the Vicks produced increased mucous in the patient's airway, which was already inflamed and narrowed because of her respiratory infection," Rubin explained.
To confirm that the menthol-containing rub was responsible for the patient's respiratory stress, researchers tested the product on ferrets. Indeed, they found that exposure to VapoRub increased mucous production, thereby causing inflammation in the rodents' airways.
Rubin said this case should not be viewed as an isolated incident. Although the labeling on Vicks VapoRub indicates that the product should not be used on children younger than 2 and should not be rubbed directly under the patient's nose, he said some parents may still be putting young children at risk by not paying heed to these warnings.
"I don't think that parents ignore this warning, but I think they feel relief when they use [Vicks VapoRub] themselves, and it's an over-the-counter drug ... and, therefore, not thought of as anything that can cause problems," Rubin explained. "But sick children may respond differently than you'd anticipate."
Although VapoRub is widely used to relieve cold and flu symptoms, there is little to no data suggesting that the product actually helps clear airways. This new study provides the first findings that suggest not only that the product doesn't help cold and flu patients, but that it may actually cause harm to some.
VapoRub has been known as a mainstay in many family medicine cabinets for years. In the past five years alone, Procter & Gamble shipped one billion units of the product globally.
According to Procter & Gamble spokesperson David Bernens, the market surveillance data obtained by the makers of Vicks does not coincide with the findings of this report. Bernens said they see only about three adverse events per one million units of Vicks VapoRub sold.
"For generations Vicks has been shown to be safe and effective if used in accordance with the instructions on the bottle," Bernens said. "Animal findings have unknown clinical relevance, and the safety of Vicks VapoRub has been shown in multiple clinical trials in over 1,000 children who were studied, ranging in age from one month old to 12 years old."