Management of Nonproductive Dry Cough
For a patient with nonproductive dry cough without available PRN medications, dextromethorphan is recommended as the first-line treatment due to its substantial benefit and favorable safety profile compared to other antitussives. 1, 2
First-Line Treatment Options
- Dextromethorphan is the most effective non-prescription cough suppressant with proven efficacy for symptomatic relief of dry cough 1, 2
- The maximum cough reflex suppression occurs at 60 mg with prolonged effect, though standard over-the-counter preparations may contain lower doses 3, 4
- Available as extended-release formulations providing up to 12 hours of relief 2
- Simple home remedies like honey and lemon mixtures can be effective first approaches for symptomatic relief 3
- Adequate hydration helps manage symptoms and should be encouraged 3
- Menthol lozenges or inhalation provides short-term cough suppression through cold and menthol sensitive receptors 1, 3
Second-Line Options
- First-generation antihistamines with sedative properties can be particularly helpful for nocturnal cough 3, 5
- Benzonatate can be considered for opioid-resistant cough when other options fail 1
- Codeine may be used for short-term symptomatic relief in patients with chronic bronchitis, but has limited efficacy for cough due to upper respiratory infections 1, 6
Not Recommended
- Antibiotics are not recommended for nonproductive cough due to viral infections, even when phlegm is present 1, 3
- Expectorants, mucolytics, and bronchodilators (like albuterol) are not recommended for acute nonproductive cough 1
- Preparations containing zinc are not recommended for acute cough due to common cold 1
Clinical Considerations
- Dextromethorphan has been shown to be more effective than codeine in controlling cough with fewer side effects 1, 4, 7
- Caution should be exercised when using higher doses of dextromethorphan as some preparations contain other ingredients like paracetamol 3, 4
- Codeine and other opioids carry risks of respiratory depression, hypoventilation, drowsiness, and physical dependence 1, 8
When to Seek Further Medical Attention
The patient should be advised to seek medical attention if they experience:
- Coughing up blood 1
- Breathlessness 1
- Prolonged fever and feeling unwell 1
- Underlying conditions like COPD, heart disease, diabetes, or asthma 1
- Recent hospitalization 1
- Symptoms persisting for more than three weeks 1
Practical Advice
- If the patient is a smoker, they should be advised to stop smoking as it worsens cough symptoms 1
- Proper cough hygiene (using a handkerchief, hand washing) should be practiced to prevent spreading infection 1
- Most nonproductive coughs are self-limiting and will resolve without specific treatment, particularly when caused by viral upper respiratory infections 3, 9