What is the recommended management for a dry cough?

Management of Dry Cough

For dry cough management, simple home remedies like honey and lemon are recommended first-line, with dextromethorphan being the preferred pharmacological option when needed due to its efficacy and better safety profile compared to other antitussives. 1

First-Line Approach

• Acute viral cough is typically benign and often does not require prescribed medication 1
• Simple home remedies such as honey and lemon are the simplest, cheapest, and often effective first-line treatment 1
• Voluntary suppression of cough may be sufficient to reduce cough frequency through central modulation of the cough reflex 1

Pharmacological Options

Recommended Agents

• Dextromethorphan:

  • Non-sedating opiate that effectively suppresses the cough reflex 1
  • Shown to be effective in meta-analysis for acute cough 1
  • Dose-response relationship exists with maximum cough suppression at 60 mg 1
  • Studies show it reduces cough frequency similar to codeine but with better reduction in cough intensity 2
  • Available in many over-the-counter preparations 3
  • Caution: Higher doses require care as some preparations contain additional ingredients like paracetamol 1

• Menthol:

  • Suppresses cough reflex when inhaled 1
  • Can be prescribed as menthol crystals or proprietary capsules 1
  • Effect is acute and short-lived 1

• First-generation antihistamines:

  • Those with sedative properties can suppress cough 1
  • Particularly useful for nocturnal cough due to sedative effects 1
  • Chlorpheniramine is commonly used for non-specific cough 4

Not Recommended

• Codeine and pholcodine:
  • No greater efficacy than dextromethorphan 1
  • Have significant adverse side effect profiles 1
  • Not recommended despite traditional use in Europe 1, 2

Special Considerations

Warning Signs Requiring Further Assessment

• Cough with increasing breathlessness should be assessed for asthma or anaphylaxis 1
• Cough with fever, malaise, purulent sputum may indicate serious lung infection 1
• Significant hemoptysis or possible foreign body inhalation requires specialist referral 1
• Cough lasting more than 7 days, recurring cough, or cough with fever, rash, or persistent headache may indicate serious conditions requiring medical evaluation 3

Contraindications and Precautions

• Dextromethorphan should not be used with MAOIs (monoamine oxidase inhibitors) 3
• Contains sodium metabisulfite which may cause allergic reactions in sensitive individuals 3
• Caution in patients with chronic cough associated with smoking, asthma, or emphysema 3
• Pregnant or breastfeeding women should consult healthcare professionals before use 3

Epidemiology and Impact

• Dry cough is common, affecting up to 16-18% of general populations 1
• More prevalent in women than men, possibly due to increased cough reflex sensitivity 1
• Can significantly impact quality of life when persistent 1
• Associated with physical symptoms (chest pain, sleep disturbance), psychological impact (depression, worry), and social disruption 1

Emerging Treatments

• Non-sedating antihistamine combinations (bilastine with dextromethorphan and phenylephrine) show promise for cough associated with common cold or allergy with less drowsiness 5
• Other centrally acting drugs like amitriptyline, paroxetine, gabapentin have shown success in case reports for chronic cough 6