What is the recommended treatment for a normal cough?

Treatment Recommendations for Normal Cough

For most cases of normal cough, supportive care is recommended as the first-line approach since most coughs are self-limiting. 1

First-Line Approach for Normal Cough

• Supportive measures:
  • Adequate hydration to thin mucus secretions
  • Humidified air to soothe irritated airways
  • Rest to support recovery
  • Honey (for adults and children >1 year) for symptomatic relief

Pharmacological Management Based on Cough Type

For Dry, Non-Productive Cough:

• Dextromethorphan is recommended as a favorable option for short-term cough suppression

  • Dosage: 30 mg every 6-8 hours, not exceeding 120 mg in 24 hours 1
  • Note: Studies show mixed results regarding efficacy, with some showing limited benefit 2

• Peripheral cough suppressants like levodropropizine may be considered as alternatives 1

  • These may have fewer side effects than central-acting suppressants

• First-generation antihistamines can be useful for nocturnal cough

  • Particularly beneficial when cough disrupts sleep due to their sedating properties 1

For Productive Cough:

• Guaifenesin is recommended as first-line treatment
  • Helps loosen phlegm and thin bronchial secretions to make coughs more productive 3
  • Dosage: 200-400 mg every 4 hours, not exceeding 2400 mg daily 1

Important Considerations and Cautions

• Avoid codeine and folcodine as they have no greater efficacy than dextromethorphan but present a much higher profile of side effects 1

• Antibiotics are not recommended for viral cough as they are ineffective and contribute to antibiotic resistance 1

• Over-the-counter combination cold medications are not recommended due to lack of proven efficacy 1

• Seek medical attention if:

  • Cough persists beyond 3 weeks (chronic cough)
  • Accompanied by hemoptysis, significant breathlessness, or prolonged fever
  • Patient has pre-existing conditions with worsening cough 1

Special Populations

Elderly patients:

• Should seek medical evaluation if cough persists beyond 1-2 weeks or is accompanied by concerning symptoms 1
• May be more susceptible to side effects of antitussives

Breastfeeding mothers:

• Use lowest effective dose for shortest duration
• Take medications immediately after breastfeeding to minimize infant exposure 1

When to Consider Further Evaluation

If cough persists beyond 3 weeks, evaluate for common causes:

• Upper airway cough syndrome
• Asthma
• Gastroesophageal reflux disease
• Non-asthmatic eosinophilic bronchitis
• ACE inhibitor use 1

For chronic cough not responding to specific treatments, consider referral to a specialist cough clinic 1.