What is the recommended treatment for a dry cough?

Treatment Recommendations for Dry Cough

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

First-Line Approach

• Acute viral cough is typically benign and often does not require prescribed medication 2
• Simple home remedies such as honey and lemon are the simplest, cheapest, and often effective first-line treatment 2, 1
• Voluntary suppression of cough may be sufficient to reduce cough frequency through central modulation of the cough reflex 2

Pharmacological Options (if home remedies are insufficient)

Recommended Medications:

• Dextromethorphan:

  • Non-sedating opiate that effectively suppresses the cough reflex 2, 1, 3
  • Shown to be effective in meta-analysis for acute cough 2
  • Dose-response relationship exists with maximum cough suppression at 60 mg 2
  • Use with caution as some preparations contain additional ingredients like paracetamol 2

• Menthol:

  • Suppresses cough reflex when inhaled 2, 1
  • Can be prescribed as menthol crystals or proprietary capsules 2
  • Effect is acute and short-lived 2

• First-generation antihistamines:

  • Those with sedative properties can suppress cough 2
  • Particularly useful for nocturnal cough due to sedative effects 2, 1

Not Recommended:

• Codeine and pholcodine:
  • Have no greater efficacy than dextromethorphan 2, 1
  • Have significant adverse side effect profiles including potential for dependence 2
  • Despite FDA approval for cough 4, not recommended due to safety concerns 2

Treatment Algorithm

1. Start with non-pharmacological approaches:

   • Honey and lemon mixtures 2, 1
   • Adequate hydration 1
   • Voluntary cough suppression techniques 2

2. If insufficient relief, progress to over-the-counter medications:

   • Dextromethorphan-containing products (preferred) 2, 1, 5
   • Menthol lozenges or inhalations for quick, short-term relief 2, 1

3. For nighttime cough disrupting sleep:

   • First-generation antihistamines with sedative properties 2, 1
   • Dextromethorphan at appropriate dosing 2

4. For persistent cough despite above measures:

   • Evaluate for underlying causes (asthma, GERD, post-nasal drip) 6
   • Consider combination products containing dextromethorphan with antihistamines 7, 5

Special Considerations

• Recent research shows non-sedating antihistamine combinations (bilastine/dextromethorphan/phenylephrine) may be effective for dry cough with less drowsiness than traditional combinations 5
• Cough with increasing breathlessness should be assessed for asthma or anaphylaxis 1
• Cough with fever, malaise, purulent sputum may indicate serious lung infection requiring different treatment 1
• Significant hemoptysis requires specialist referral 1
• Evidence for OTC medications in children is limited and potential risks may outweigh benefits 8

Common Pitfalls to Avoid

• Overuse of codeine-containing products due to adverse effects and addiction potential 2, 1
• Using subtherapeutic doses of dextromethorphan (common in some OTC preparations) 2
• Ignoring persistent cough that could indicate underlying conditions 6
• Failing to recognize that dry cough significantly impacts quality of life and may require more aggressive management if persistent 1, 9