What are the treatment options for a viral cough?

Treatment Options for Viral Cough

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

First-Line Treatment Options

• Most short-term coughs are due to viral infections and are self-limiting; antibiotics are not helpful even if phlegm is present 1
• Honey and lemon mixture is the simplest, cheapest, and often effective first approach for viral cough 1, 2
• Simple voluntary suppression of cough may be sufficient to reduce cough frequency in many cases 1
• Adequate hydration helps thin secretions and makes coughs more productive 2

Over-the-Counter Medication Options

• Dextromethorphan is a non-sedating antitussive that has been shown to suppress cough in meta-analyses 1, 3

  • Maximum cough reflex suppression occurs at 60 mg with prolonged effect 1
  • Care must be taken with higher doses as some preparations contain other ingredients like paracetamol 1

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

  • Works through the cold and menthol sensitive receptor (CMR1) 1

• Guaifenesin helps loosen phlegm and thin bronchial secretions to make coughs more productive 4

  • Evidence for effectiveness is mixed, with some studies showing benefit and others showing no difference from placebo 5, 6

• First-generation antihistamines with sedative properties can suppress cough 1

  • May be particularly suitable for nocturnal cough due to their sedating effect 1
  • However, studies show conflicting results regarding their effectiveness 5, 6

Not Recommended

• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile 1, 7
• Antibiotics have no role in treating viral cough 1

When to Seek Medical Attention

You should see a doctor if you experience any of the following:

• Coughing up blood 1
• Breathlessness 1
• Prolonged fever and feeling unwell 1
• Underlying medical conditions such as chronic bronchitis (COPD), heart disease, diabetes, asthma 1
• Recent hospitalization 1
• Symptoms persisting for more than three weeks 1

Special Considerations

• For postinfectious cough (lasting 3-8 weeks after a respiratory infection), inhaled ipratropium may be considered if cough is persistent 1
• For severe paroxysms of postinfectious cough, prednisone (30-40 mg daily for a short period) may be considered when other common causes have been ruled out 1
• Stop smoking, as it worsens cough and respiratory symptoms 1
• Use proper cough hygiene (handkerchief, hand washing) to prevent spreading infection 1

Practical Approach

1. Start with honey and lemon mixture and ensure adequate hydration
2. If insufficient relief, try dextromethorphan-containing cough preparations
3. For nighttime symptoms, consider sedating antihistamines
4. For productive cough, consider guaifenesin to help loosen mucus
5. Use menthol lozenges or vapors for quick, temporary relief
6. Seek medical attention if warning signs are present or cough persists beyond 3 weeks