What is the treatment for cough?

From the Guidelines

For cough treatment, the most effective approach is to sequentially evaluate and treat for the common causes of cough using a combination of selected diagnostic tests and empiric therapy, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1.

Initial Assessment

When evaluating a patient with cough, it is essential to determine whether the cough is acute, subacute, or chronic, as this will guide the treatment approach. The medical history is crucial in determining the underlying cause of the cough, including the possibility of multiple causes.

Treatment Approach

The treatment approach should start with the most common causes of cough, including upper airway secretions (UACS), asthma, and gastroesophageal reflux disease (GERD) 1.

• For UACS, treatment with antihistamines and decongestants may be effective.
• For asthma, treatment with inhaled corticosteroids (ICS) and bronchodilators (BD) may be necessary.
• For GERD, treatment with proton pump inhibitors (PPI) and lifestyle modifications may be effective.

Additional Considerations

In patients with postinfectious cough, a trial of inhaled ipratropium may be considered, as it may attenuate the cough 1.

• In patients with severe paroxysms of postinfectious cough, a short course of prednisone (30-40 mg per day) may be prescribed.
• Central acting antitussive agents such as codeine and dextromethorphan may be considered when other measures fail.

General Measures

In addition to treating the underlying cause of the cough, general measures such as staying hydrated, using a humidifier, and avoiding irritants like smoke can help alleviate symptoms and prevent cough triggers 1.

• Elevating the head with extra pillows at night can also help relieve nighttime cough.
• If the cough persists beyond 2-3 weeks, is accompanied by fever, produces discolored phlegm, or causes breathing difficulties, consultation with a doctor is necessary.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants Purpose Cough suppressant

The treatment for cough includes:

• Guaifenesin (PO) to loosen phlegm and thin bronchial secretions, making coughs more productive 2
• Dextromethorphan (PO) as a cough suppressant to temporarily relieve cough due to minor throat and bronchial irritation 3 3

From the Research

Treatment Approaches for Cough

• The treatment of cough can be divided into two main approaches: disease-specific and symptom-related antitussives 4.
• Disease-specific therapies aim to treat the underlying cause of the cough, while symptom-related antitussives focus on suppressing the cough itself 4, 5.
• In cases where the underlying cause of the cough cannot be established or treated, symptom-related antitussives may be necessary 4.

Symptom-Related Antitussives

• Centrally acting opioids such as morphine, codeine, pholcodeine, and dextromethorphan are commonly used cough suppressants 4.
• However, the efficacy of these medications can be limited, and high doses may be associated with side effects 4, 6.
• Peripherally acting antitussives such as levodropropizine and moguisteine have shown promise in treating cough, particularly in children 7.

Management of Chronic Cough

• Chronic cough can be challenging to manage, and a step-wise approach is often necessary 8.
• This approach includes identifying and treating underlying causes such as asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease, and upper airway cough syndrome 8.
• In cases of refractory chronic cough, individualized treatment plans may be necessary, including pharmacological and non-pharmacological interventions 5, 8.

Acute Cough Treatment

• Acute cough is often self-limiting and may not require medication 5.
• However, in cases where treatment is necessary, symptom-related antitussives such as dextromethorphan may be used, although their efficacy has been questioned 6.
• A targeted and appropriate approach to evaluating and treating acute cough is essential to avoid missing underlying serious conditions 5.