What are the treatment options for cough?

Treatment Options for Cough

For most short-term coughs, home remedies like honey and lemon are recommended as first-line treatment, while dextromethorphan-containing products are the most effective over-the-counter medication for symptomatic relief. 1, 2, 3

Initial Assessment and Classification

• Determine whether the cough is productive or nonproductive, as this guides treatment approach 2, 3
• Most short-term coughs are due to viral infections and don't require antibiotics, even if phlegm is present 1
• Identify red flags that require medical attention: coughing up blood, breathlessness, prolonged fever, underlying conditions like COPD/heart disease/diabetes/asthma, recent hospitalization, or symptoms persisting >3 weeks 1, 3

Treatment Algorithm for Acute Cough

For Nonproductive (Dry) Cough:

• First-line options:

  • Dextromethorphan (60mg provides maximum cough suppression with prolonged effect) 3, 4
  • Honey and lemon mixtures for symptomatic relief 1, 3
  • Menthol lozenges or vapor for short-term cough suppression 1, 3

• Second-line options:

  • First-generation antihistamines with sedative properties (particularly helpful for nocturnal cough) 3
  • Simple voluntary suppression techniques may reduce cough frequency 2

For Productive Cough:

• First-line options:

  • Adequate hydration to thin secretions 2
  • Guaifenesin to loosen phlegm and thin bronchial secretions 5
  • Honey and lemon mixtures 2

• Second-line options:

  • Dextromethorphan if cough is disruptive to sleep or daily activities 4, 6

Not Recommended

• Antibiotics for cough due to viral infections 1, 3
• Codeine or pholcodine (no greater efficacy than dextromethorphan but have more adverse effects) 2, 7
• Expectorants and mucolytics for acute nonproductive cough 3

Special Considerations

• Smoking cessation: Stop smoking as it worsens cough symptoms 1, 3
• Infection control: Use proper cough hygiene (handkerchief, hand washing) to prevent spreading infection 1
• Persistent cough: If cough persists beyond 3 weeks despite treatment, further evaluation is needed to identify potential underlying causes such as GERD, asthma, or UACS 1
• Chronic cough management: For chronic cough, treatment should target the underlying cause (GERD, asthma, UACS) rather than just symptom suppression 1

Cautions and Pitfalls

• Higher doses of dextromethorphan may be more effective but require caution as some preparations contain other ingredients like paracetamol 3
• Opioid-based cough suppressants carry risks of respiratory depression, drowsiness, and physical dependence 3, 8
• Most cough medications have limited evidence for efficacy beyond placebo effect 7, 9
• Specialized cough clinics may be beneficial for patients with persistent unexplained cough 1