What are the treatment options for a cough?

Treatment Options for Cough

For most cough cases, simple home remedies such as honey and lemon are the first-line treatment, while dextromethorphan is the most effective over-the-counter medication for symptomatic relief of acute cough. 1

Acute Cough Treatment

Home Remedies and Non-Prescription Options

• Most short-term coughs are due to viral infections and are self-limiting; antibiotics are unnecessary even if phlegm is present 1
• Home remedies like honey and lemon are recommended as first-line treatment for acute viral cough 1
• Simple voluntary suppression of cough may be sufficient to reduce cough frequency in some cases 1

Over-the-Counter Medications

• Dextromethorphan is the most effective non-prescription cough suppressant with fewer side effects than codeine 1, 2

  • Maximum cough reflex suppression occurs at 60 mg and can be prolonged 1
  • Available in extended-release formulations providing 12-hour relief 2
  • Should not be used with MAOIs or in patients with chronic productive cough 2

• Menthol by inhalation (lozenges or vapor) provides acute, short-lived cough suppression 1

• Guaifenesin helps loosen phlegm and thin bronchial secretions, making coughs more productive 3, 4

  • Particularly useful for wet cough and chest congestion 4

• First-generation antihistamines with sedative properties may be suitable for nocturnal cough but cause drowsiness 1

Medications to Avoid

• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile and are not recommended 1
• Opiate antitussives generally have significant adverse side effects and are not recommended for routine use 1, 5

Chronic Cough Treatment

Treatment Based on Underlying Cause

• Treatment should target the specific cause of chronic cough 1:
  • Gastroesophageal reflux disease (GERD): Proton pump inhibitors and prokinetic agents 1, 6
  • Postnasal drip syndrome: Antihistamines, decongestants, nasal steroids 1, 7
  • Asthma: Inhaled corticosteroids, bronchodilators 1, 7

Specific Conditions

• For confirmed whooping cough (pertussis):

  • Macrolide antibiotics are recommended, especially within the first few weeks 1
  • Patients should be isolated for 5 days from the start of treatment 1
  • Long-acting β-agonists, antihistamines, corticosteroids, and pertussis Ig are not recommended 1

• For cough associated with lung cancer:

  • Centrally acting cough suppressants such as dihydrocodeine and hydrocodone are recommended 1
  • For patients with dyspnea or hemoptysis due to endobronchial tumors, endobronchial methods should be considered 1

When to Seek Medical Attention

Consult a doctor if you experience any of the following 1:

• Coughing up blood
• Breathlessness
• Prolonged fever and feeling unwell
• Existing medical conditions such as COPD, heart disease, diabetes, asthma
• Recent hospitalization
• Symptoms persisting for more than three weeks

Special Considerations

• Patients with swallowing disorders (dysphagia) and cough should be evaluated for aspiration risk 1, 8
• Cough character, timing, and complications are not reliable diagnostic indicators of the underlying cause 7
• Multiple causes often contribute to chronic cough simultaneously, requiring sequential and additive therapy 1, 7
• Smoking cessation is essential for patients with cough who smoke 1

Preventive Measures

• All children should receive pertussis vaccination as part of a complete DTaP primary vaccination series 1
• Adults up to age 65 should receive the TDaP vaccine according to CDC guidelines 1
• Proper hygiene practices help prevent spreading respiratory infections 1