From the Guidelines
The management of a patient with a dry persistent cough begins with identifying and treating the underlying cause, and for symptomatic relief, over-the-counter cough suppressants containing dextromethorphan (15-30mg every 4-6 hours) or codeine (10-20mg every 4-6 hours) can be used for short-term management, as recommended by 1. The approach to managing a dry persistent cough involves a stepwise evaluation and treatment plan.
- Identifying the underlying cause is crucial, as it guides the treatment approach.
- For symptomatic relief, options include:
- Over-the-counter cough suppressants like dextromethorphan (15-30mg every 4-6 hours) or codeine (10-20mg every 4-6 hours) for short-term management, as suggested by 1.
- First-generation antihistamines such as diphenhydramine (25mg every 6 hours) if the cough is suspected to be allergy-related.
- Targeted treatments based on specific causes include:
- Non-pharmacological approaches are also important and include:
- Staying hydrated.
- Using a humidifier.
- Avoiding irritants like smoke or strong perfumes.
- Elevating the head while sleeping.
- Honey (1-2 teaspoons) can soothe throat irritation in adults and children over one year. If the cough persists beyond 3-4 weeks despite these measures, further investigation with chest X-rays, pulmonary function tests, or specialist referral may be necessary to rule out serious conditions like chronic lung disease or malignancy, as indicated by 1. The effectiveness of these treatments varies because dry cough has multiple potential causes, from postnasal drip and asthma to medication side effects and environmental irritants. Given the complexity and the potential for multiple causes, a systematic approach that considers the most common causes of cough, such as upper airway cough syndrome (UACS), asthma, nonasthmatic eosinophilic bronchitis (NAEB), and gastroesophageal reflux disease (GERD), is essential, as outlined in 1 and 1. For patients with chronic cough, systematically directing empiric treatment at the most common causes of cough, and considering referral to a cough specialist if the diagnosis remains unclear after initial evaluations, is a prudent approach, as suggested by 1.
From the Research
Management of Dry Persistent Cough
- The management of a patient with a dry persistent cough can be complex and may involve various treatment approaches, depending on the underlying cause of the cough 2, 3, 4, 5, 6.
- In patients with asthma, the use of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) can help manage symptoms, including cough 2, 3, 6.
- The combination of budesonide and formoterol has been shown to be effective in managing asthma symptoms, including cough, and can be used as both a maintenance and reliever medication 2, 6.
- In patients with chronic obstructive pulmonary disease (COPD), the use of oral corticosteroids may not have a significant effect on bronchodilator responses, including cough 4.
- Nebulized fluticasone propionate and budesonide can be effective in managing asthma exacerbations, including cough, in children 5.
- Single inhaler therapy, which combines a LABA and an ICS in a single inhaler, can be an effective treatment approach for managing asthma symptoms, including cough, and can reduce the risk of exacerbations needing oral corticosteroids 6.
Treatment Options
- Inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABAs) can be used to manage symptoms, including cough, in patients with asthma 2, 3, 6.
- Oral corticosteroids may not be effective in managing cough in patients with COPD 4.
- Nebulized fluticasone propionate and budesonide can be used to manage asthma exacerbations, including cough, in children 5.
- Single inhaler therapy can be an effective treatment approach for managing asthma symptoms, including cough, and can reduce the risk of exacerbations needing oral corticosteroids 6.