What is the treatment for cough?

Treatment for Cough

For acute viral cough, home remedies like honey and lemon are recommended as first-line treatment, with over-the-counter preparations containing dextromethorphan being the most effective pharmacological option if needed. 1

Classification and Assessment

Cough is classified by duration:

• Acute cough: less than 3 weeks
• Post-viral cough: 3-8 weeks
• Chronic cough: more than 8 weeks 2

When evaluating a patient with cough, assess:

• Duration of symptoms
• Productive vs. non-productive cough
• Associated symptoms (fever, dyspnea, chest pain)
• Triggers and timing
• Impact on quality of life 2

Treatment Approach Based on Cough Type

Acute Viral Cough (Most Common)

1. First-line: Non-pharmacological options

   • Home remedies: honey and lemon 1
   • Adequate hydration
   • Voluntary cough suppression techniques 1

2. Second-line: Over-the-counter medications

   • Dextromethorphan: most effective OTC antitussive 1, 2
     • Maximum cough reflex suppression occurs at 60 mg 1
   • Menthol: provides short-term cough suppression 1
   • Guaifenesin: helps loosen phlegm in productive cough 3

3. For nocturnal cough

   • First-generation antihistamines with sedative properties 1, 2

Productive Cough

• Guaifenesin to loosen phlegm and thin bronchial secretions 3
• Avoid cough suppression if productive cough is helping clear secretions 1

Chronic Cough (>8 weeks)

Treatment should target underlying causes:

1. Upper airway cough syndrome: first-generation antihistamine/decongestant combination 2
2. Asthma/bronchial hyperresponsiveness: inhaled corticosteroids and bronchodilators 2
3. GERD: proton pump inhibitors with lifestyle modifications 2
4. Refractory cases: neuromodulators like gabapentin or speech pathology therapy 2, 4

Important Cautions

• Avoid codeine and other opioid antitussives due to significant adverse side effect profiles and limited evidence of superior efficacy compared to dextromethorphan 1, 4
• Antibiotics are not helpful for viral cough, even if producing phlegm 1
• Smoking cessation is essential for those who smoke 1

When to Seek Medical Attention

Consult a doctor if:

• Coughing up blood
• Experiencing breathlessness
• Having prolonged fever and feeling unwell
• Having an underlying medical condition (COPD, heart disease, diabetes, asthma)
• Recently hospitalized
• Symptoms persist for more than three weeks 1

Special Populations

Cancer Patients with Cough

For lung cancer patients with persistent cough, a comprehensive assessment should be performed to identify treatable causes before symptomatic management 1

Children and Elderly

Evidence for OTC cough medications in children is limited, with studies showing conflicting results 5. Use caution with sedating antihistamines in elderly patients due to increased risk of adverse effects.