What is the treatment for sudden severe coughing?

Treatment for Sudden Severe Coughing

For sudden severe coughing, first-generation antihistamine/decongestant combinations are the most effective first-line treatment, with centrally acting cough suppressants like codeine or dextromethorphan recommended for short-term symptomatic relief when necessary. 1

Initial Assessment

• Determine the likely cause of cough based on duration and associated symptoms:

  • Acute cough: lasting <3 weeks 1
  • Subacute cough: lasting 3-8 weeks 1
  • Chronic cough: lasting >8 weeks 1

• Assess for warning signs requiring immediate attention:

  • Respiratory distress, tachypnea, dyspnea, abnormal lung findings 2
  • High fever (>38.5°C), hemoptysis, or altered mental status 2

Treatment Based on Likely Cause

For Common Cold/Upper Respiratory Infection

• First-generation antihistamine plus decongestant combination (e.g., dexbrompheniramine maleate plus pseudoephedrine) is strongly recommended 1
• Newer-generation nonsedating antihistamines should NOT be used as they are ineffective for cough 1
• Consider naproxen (Naprosyn, Aleve) which has been shown to favorably affect cough in controlled studies 1

For Dry, Nonproductive Cough

• Short-term use of centrally acting cough suppressants:
  • Codeine or dextromethorphan for symptomatic relief 1
  • Dextromethorphan should not be used if taking MAOIs 3
  • Avoid use if cough is productive or occurs with excess phlegm 3

For Productive Cough

• Avoid cough suppressants if cough is productive with phlegm 3
• Adequate hydration to help thin secretions 2
• Consider honey for cough suppression in patients over 1 year of age 2

For Bronchospasm/Asthma-Related Cough

• Short-acting inhaled β-agonists like albuterol may improve cough 1, 4
• Administer via nebulizer or inhaler and monitor response 4

Duration-Based Approach

For Acute Cough (<3 weeks)

• First-generation antihistamine/decongestant combinations 1
• Avoid antibiotics unless specific bacterial infection is suspected 1
• Consider centrally acting cough suppressants for short-term relief 1, 5

For Subacute Cough (3-8 weeks)

• Determine if cough is post-infectious or has another cause 1
• For post-infectious cough, first-generation antihistamine/decongestant combinations are effective 1
• If not post-infectious, evaluate and manage as chronic cough 1

Important Considerations

• Antibiotics are rarely indicated for acute cough unless there is evidence of:

  • Bacterial pneumonia 1
  • Pertussis (within first few weeks) 1
  • Bacterial sinusitis 1

• Avoid over-the-counter combination medications except those containing older antihistamine/decongestant ingredients 1

• Stop treatment and seek medical attention if:

  • Cough persists beyond 7 days 3
  • Cough is accompanied by fever, rash, or persistent headache 3
  • Symptoms worsen despite appropriate treatment 2

Cautions and Contraindications

• First-generation antihistamines may cause sedation, dry mouth, and dizziness 1
• Avoid decongestants in patients with glaucoma, benign prostatic hypertrophy, or hypertension 1
• Dextromethorphan is contraindicated in patients taking MAOIs 3
• Cough suppressants should be avoided in productive cough as they may impair clearance of secretions 5, 6