What is the treatment for cough?

Treatment for Cough

The most effective approach to treating cough is to identify and address the underlying cause while providing appropriate symptomatic relief based on whether the cough is productive or non-productive. 1, 2

Initial Assessment and Classification

Acute Cough (< 3 weeks)

• Most commonly due to viral respiratory infections
• First determine if cough represents a serious illness such as pneumonia or pulmonary embolism 1
• Warning signs requiring immediate medical attention:
  • Coughing up blood
  • Breathlessness
  • Prolonged fever
  • Recent hospitalization
  • Underlying medical conditions 2

Subacute Cough (3-8 weeks)

• Often post-infectious
• Evaluate if it's resolving or requires further intervention 1

Chronic Cough (> 8 weeks)

• Requires systematic evaluation for common causes:
  • Upper airway cough syndrome (post-nasal drip)
  • Asthma
  • Gastroesophageal reflux disease (GERD)
  • Non-asthmatic eosinophilic bronchitis 1, 3

Treatment Algorithm

1. Home Remedies (First-Line for Acute Viral Cough)

• Honey and lemon mixture (most effective natural remedy) 2
• Adequate hydration
• Menthol lozenges or vapor for symptomatic relief 2
• Avoid smoking and secondhand smoke exposure 2

2. Productive Cough (with phlegm)

• Guaifenesin to loosen phlegm and thin bronchial secretions 4
• Avoid suppressing productive cough in conditions like pneumonia and bronchiectasis where cough clearance is important 1

3. Non-Productive (Dry) Cough

• Dextromethorphan (15-30 mg three times daily) - non-sedating option with favorable side effect profile 2, 5
• For severe cases or nighttime symptoms: Codeine-containing preparations may be considered, but with caution due to side effects and potential for dependence 6, 7

4. Persistent Post-Infectious Cough (3-8 weeks)

• Stepwise approach:
  1. Inhaled ipratropium bromide (2 puffs, 36 mcg, four times daily) 2
  2. If cough persists after 3-5 days, add inhaled corticosteroids 2
  3. For severe paroxysmal cough, consider short course of oral prednisone (30-40 mg daily for 5-7 days) 2

5. Chronic Cough Management

• Address specific underlying causes:

  • Upper airway cough syndrome: Antihistamine/decongestant combinations 1
  • Asthma: Inhaled corticosteroids and bronchodilators 1
  • GERD: Proton pump inhibitors, dietary measures, and consider prokinetic agents 1
  • ACE inhibitor-induced: Discontinue medication 2

• For refractory chronic cough:

  • Neuromodulators (gabapentin or pregabalin) 3
  • Speech therapy and cough suppression techniques 1, 3
  • Low-dose morphine may be considered for idiopathic chronic cough 1

Special Considerations

Lung Cancer

• For patients with cough due to lung cancer, centrally acting cough suppressants such as dihydrocodeine and hydrocodone are recommended 1
• Consider radiation therapy for symptomatic relief in advanced cases 1

Pertussis (Whooping Cough)

• Macrolide antibiotics (azithromycin, clarithromycin, or erythromycin) within first 5 days 1
• Avoid antihistamines, corticosteroids, and pertussis Ig as they show no benefit 1

Common Pitfalls to Avoid

1. Using antibiotics for viral or post-viral cough without evidence of bacterial infection 2
2. Continuing ACE inhibitors in patients with persistent cough 2
3. Overlooking GERD as a potential cause of persistent cough 2
4. Overreliance on opioid antitussives leading to dependence 2
5. Failing to consider alternative diagnoses when cough persists beyond 8 weeks 2

Remember that cough is a protective reflex, and complete suppression is not always desirable, particularly with productive cough where clearing secretions is beneficial. The goal should be to address the underlying cause while providing symptomatic relief that improves quality of life.