From the Guidelines
For outpatient cough management, demulcents such as butamirate linctus (syrup) or simple linctus (syrup) or glycerin-based linctus (syrup) are the preferred initial treatment option. According to the Chest guideline and expert panel report 1, these demulcents are suggested as the first step in pharmacological therapy for adult patients with lung cancer experiencing cough. The guideline recommends an initial trial with these demulcents where available, with a Grade 2C suggestion.
Key Points to Consider
- Demulcents work by forming a protective layer on the mucous membranes, helping to soothe and calm the cough reflex.
- Butamirate linctus, simple linctus, and glycerin-based linctus are all effective options, and the choice may depend on availability and patient preference.
- It's essential to note that if the cough does not respond to demulcents, other pharmacological management options, such as opiate-derivative titrated to an acceptable side-effect profile, may be considered 1.
- For opioid-resistant cough, peripherally-acting antitussives like levodropropizine, moguisteine, levocloperastine, or sodium cromoglycate may be suggested 1.
Important Considerations
- Cough is a common symptom affecting patients with lung cancer, and its management is crucial for improving quality of life.
- The management of cough should be comprehensive, considering the complex interrelationships with other symptoms like breathlessness and fatigue.
- Treatment decisions should be based on evidence-based guidelines, and patients should be encouraged to seek medical evaluation if symptoms persist or worsen.
From the FDA Drug Label
Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Active Ingredients Purpose (in each teaspoonful (5 mL)) Codeine Phosphate USP 10 mg ................... Antitussive Guaifenesin USP 100 mg ........................... Expectorant The preferred tussin for outpatient cough is not explicitly stated in the provided drug labels.
- Guaifenesin is an expectorant that helps loosen phlegm and thin bronchial secretions to make coughs more productive 2.
- Codeine is an antitussive, and guaifenesin is an expectorant in a combination product 3. No conclusion can be drawn about the preferred tussin for outpatient cough.
From the Research
Preferred Tussin for Outpatient Cough
- The choice of tussin for outpatient cough depends on various factors, including the patient's medical history and current health status.
- According to a study published in 1983 4, dextromethorphan was found to be more effective in reducing cough intensity than codeine, with fewer side effects.
- A 1993 study 5 compared the effectiveness of three cough syrups, including guaifenesin, guaifenesin plus codeine, and guaifenesin plus dextromethorphan, and found no statistically significant differences among the treatment groups.
- In terms of safety, a 2011 review 6 recommended that dextromethorphan can be used in most transplant recipients, but with caution in patients with liver impairment, while codeine can be used in most transplant patients, but with careful monitoring in those with reduced renal function.
- A 2019 review 7 of treatments for the common cold found that over-the-counter analgesics, zinc, nasal decongestants, and ipratropium were effective in adults, but noted that over-the-counter cold medications should not be used in children younger than four years.
Comparison of Cough Suppressants
- Dextromethorphan and codeine are two commonly used cough suppressants, with dextromethorphan being considered a safer alternative due to its non-narcotic status and lack of side effects 4.
- Guaifenesin is another option for cough, but should be used with caution in patients with renal impairment 6.
- Ipratropium is also effective in treating cough, particularly in adults 7.