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. When managing cough, it is essential to consider the duration and potential causes of the cough, whether acute, subacute, or chronic.

• For acute cough, the initial decision is to determine if it is a manifestation of a serious condition, such as pneumonia or pulmonary embolism, or a common cold, acute bronchitis, or asthma syndrome 1.
• For subacute cough, the crucial distinction is whether it is postinfectious or not, and if postinfectious, consider conditions like transient bronchial hyperresponsiveness, asthma, pertussis, or acute exacerbation of chronic bronchitis 1.
• For chronic cough, an algorithm-based approach is recommended, considering the frequency of different causes, the value of selected diagnostic tests, and empiric therapy, as well as the expected timeframe of response 1. In terms of specific treatments, over-the-counter options like dextromethorphan (10-30 mg every 4-6 hours) for dry coughs or guaifenesin (200-400 mg every 4 hours) for productive coughs can be effective, as well as home remedies like honey and lemon 1. Additionally, staying hydrated with 8-10 glasses of water daily, using a humidifier to moisten dry air, and avoiding irritants like smoke can provide relief.
• If the cough persists beyond 2-3 weeks, is accompanied by fever over 100.4°F, shortness of breath, or produces discolored mucus, seeking medical attention is recommended, as prescription medications may be needed 1.

From the FDA Drug Label

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

The treatment for cough includes:

• Expectorants like guaifenesin to loosen phlegm and make coughs more productive 2
• Cough suppressants like dextromethorphan to relieve cough due to minor throat and bronchial irritation 3 3

From the Research

Treatment Approaches for Cough

• The treatment of cough depends on the underlying cause, with specific treatments aimed at eliminating the cough 4.
• In cases where the cause of cough cannot be established or treatment of the cause fails, suppression of cough may be necessary, which can be disease-specific or symptom-related 4.
• For acute cough, the most effective treatment is often a combination of a first-generation antihistamine and a decongestant 5.
• Antibiotics are not typically indicated for most cases of acute cough, unless there are signs of a bacterial infection 5.

Medications Used to Treat Cough

• 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.
• Other medications such as amitriptyline, paroxetine, gabapentin, and carbamezepine have been reported to be effective in treating chronic cough in some cases 4.
• Dextromethorphan has been shown to have limited antitussive efficacy in the treatment of cough associated with acute upper respiratory tract infection 6.

Management of Acute and Chronic Cough

• Acute and chronic cough are differentiated based on the duration of symptoms, with acute cough lasting up to 8 weeks and chronic cough lasting longer than 8 weeks 7.
• The management of cough depends on the underlying cause and may involve specific therapies, symptomatic treatments, or a combination of both [(7,8)].
• A comprehensive approach to the management of cough should take into account the patient's medical history, symptoms, and preexisting conditions 8.