Reference
Raeessi MA, Aslani J, Raeessi N, et al. Honey plus coffee versus systemic steroid in the treatment of persistent post-infectious cough: a randomised controlled trial. Prim Care Respir J. 2013;22(3):325-330.
Design
A double-blind randomized controlled trial conducted from 2008 to 2011 comparing the effectiveness of 3 treatments for reducing severity of persistent coughs that followed upper respiratory infections
Participants
A total of 97 adults who had experienced persistent postinfectious cough for more than 3 weeks took part in this study. Individuals with other causes of chronic cough or systemic disease, smokers, and individuals who had abnormal routine lab tests were excluded. Mean age of participants was 40, and mean duration of illness was 2.9 months.
Study Medication and Dosage
Subjects were divided into 3 groups to receive 1 of 3 regimens that were prepared and packaged as a jam-like paste:
- Honey and coffee: 20.8 g of honey and 2.9 g of Nestle instant coffee per 1 T dose taken 3 times per day;
- Steroids: 13.3 mg prednisolone per 1 T dose taken 3 times per day; or
- Control group: 25 g guaifenesin per 1 T dose taken 3 times per day.
Participants dissolved approximately 1 T of their specific paste in a glass of warm water every 8 hours (3x/d) for 1 week. All products were prepared and packaged by pharmacists to have similar appearance, flavor, and packaging.
Outcome Measures
Cough frequency was evaluated before treatment and 1 week after treatment was completed using a specially designed and validated questionnaire that was completed by physicians who interviewed and evaluated the patients. The questionnaire graded coughs on a scale of 0 (low) to 3 (high).
Key Findings
The 3 groups were similar in all variables including age and cough frequency at the start of the study. Changes in cough frequency before and after the treatment period were significant for the honey/coffee group and the steroid group. No significant change was detected in the control group (Table 1). The difference in cough frequency before and after treatment was not significantly different between the steroid and control groups. The decrease in cough frequency for the honey-coffee group was statistically significant and significantly greater than in the steroid or control groups.
Table 1. Mean Cough Frequency (0-3) in 3 Groups Pretreatment and Posttreatment in 2013 Study | |||
| Coffee and Honey Group | Steroid Group | Control Group |
Pretreatment | 2.9 | 3.0 | 2.8 |
Posttreatment | 0.2 | 2.4 | 2.7 |
Source: Raeessi MA, Aslani J, Raeessi N, et al. Honey plus coffee versus systemic steroid in the treatment of persistent post-infectious cough: a randomised controlled trial. Prim Care Respir J. 2013;22(3):325-330. | |||
Practice Implications
A mixture of honey and instant coffee was significantly more effective at relieving persistent cough than steroids or placebo. This treatment is safe, effective, pleasant tasting, inexpensive, and uses natural food ingredients. What more could we ask for?
The use of honey for medicine dates back far into prehistory. In Iran, where this current trial was performed, use of honey in traditional medicine goes back thousands of years to ancient Persia, where mixtures of honey cooked with vinegar, known as oxymel, were used for a variety of medicinal purposes and also as the base for hundreds of specific herbal compounds.1
This is the second study by these authors using honey and coffee to treat persistent cough. Their earlier paper, published in 2011, compared the effect of instant coffee or honey individually against a combination of the 2 in a group of 84 subjects with persistent cough. The combination of coffee and honey was significantly superior at reducing persistent cough than either ingredient alone (Table 2).2
Table 2. Mean Cough Frequency (0-3) in 3 Groups Pretreatment and Posttreatment in 2011 Study | |||
| Coffee Group | Honey Group | Coffee and Honey Group |
Pretreatment | 3.0 | 3.0 | 3.0 |
Posttreatment | 1.8 | 1.4 | 0.4 |
Source: Raeessi MA, Aslani J, Gharaie H, Karimi Zarchi AA, Raeessi N, Assari S. Honey with coffee: a new finding in the treatment of persistent postinfectious cough. Iran J Otorhinolaryngol. 2011; 23(63):1-8. | |||
A number of mechanisms may underlie honey’s medicinal action, including acidity, osmolality, and hydrogen peroxide production.3 Honey reduces prostaglandin synthesis in the area of application, increases nitric oxide levels, and has antioxidant effect.4 In a study using a rabbit model of asthma, aerosolized honey “resulted in structural changes of the epithelium, mucosa, and submucosal regions of the airway. . .[and] reduced the number of airway inflammatory cells present in bronchoalveolar lavage fluid and inhibited the goblet cell hyperplasia.”5
It has been suggested that any material that tastes sweet will reduce cough.6 This effect may be simply due to the high osmolality of honey as it stimulates the salivation reflex and hypersecretion of airway mucus, which in turn improves mucociliary clearance in the pharynx and reduces cough. A 2012 double-blinded randomized control trial from Israel reported that honey alone was significantly superior to other treatments for nighttime coughs in children.7 The Journal of Family Practice described these results as a ‘game changer’ in clinical practice.8
Although a March 2012 Cochrane review, in its hallmark cautious style, allowed only that “Honey may be better than 'no treatment,'”9 honey is starting to look like something we should employ more often in practice—particularly, it would seem, in combination with coffee. Why does the combination work so well? We are not really sure.
In 2011 Nosáľová et al identified an arabinogalactan-protein extract from instant coffee that does have an antitussive effect.10 There have been suggestions that coffee or the caffeine in it might act as a bronchodilator and so improve the cough. Yet, the small amount of caffeine used in these studies is probably not adequate to cause bronchodilation.11 [Author’s note: for readers who might ask whether decaffeinated coffee would work, we don’t know the answer yet as it is unclear whether the caffeine is essential for this mixture’s efficacy.]
Whatever the case, the combination of honey and coffee (see the recipe in the Appendix) appears to be more effective than either substance alone and is certainly worth a try for persistent cough.
Appendix. Honey and Coffee Recipe Based on Studies Reviewed |
500 g honey (about 1 lb) |
70 g of instant coffee (about 2.5 oz dry weight or 13 T or 6.5 oz liquid measure) |
Mix the honey and coffee and add 1 T of it to 1 cup of warm water and drink it 3 times a day, about every 8 hours. |
