What is the recommended management for a cough caused by weather change?

Management of Cough Due to Weather Change

For cough due to weather change, the simplest and most effective first-line treatment is a home remedy such as honey and lemon, along with adequate hydration to thin secretions. 1, 2

First-Line Treatment Options

• Simple voluntary suppression of cough may be sufficient to reduce cough frequency in many cases 1, 2
• Honey and lemon mixtures are the simplest, cheapest, and often effective first approach 1, 2
• Adequate hydration helps thin secretions and makes coughs more productive 2
• Dextromethorphan is recommended for short-term symptomatic relief when non-pharmacological approaches are insufficient 1, 3
• Maximum cough reflex suppression occurs at 60 mg of dextromethorphan with prolonged effect (standard OTC doses are often subtherapeutic) 1, 4
• Menthol by inhalation provides acute, short-lived cough suppression and can be prescribed as menthol crystals or proprietary capsules 1, 2

Second-Line Options

• First-generation antihistamines with sedative properties can suppress cough and may be particularly suitable for nocturnal cough due to their sedating effect 1, 4, 5
• Ipratropium bromide is the only inhaled anticholinergic agent recommended for cough suppression in patients with URI or chronic bronchitis 1

Not Recommended

• Central cough suppressants like codeine have limited efficacy for cough due to URI and are not recommended 1
• Codeine or pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile 1, 4
• In patients with acute cough due to the common cold, over-the-counter combination cold medications (except older antihistamine-decongestant combinations) are not recommended 1
• Albuterol is not recommended for acute or chronic cough not due to asthma 1
• Zinc preparations are not recommended for acute cough due to the common cold 1

Special Considerations

• Weather-related cough is typically a form of acute viral cough and is almost invariably benign 1
• If cough persists beyond 3 weeks, it should be considered chronic and warrants further investigation 1, 4
• Medical attention should be sought if experiencing any of these warning signs 2, 4:
  • Coughing up blood
  • Increasing breathlessness
  • Prolonged fever and feeling unwell
  • Underlying conditions like COPD, heart disease, diabetes, or asthma
  • Recent hospitalization
  • Symptoms persisting for more than three weeks

Practical Algorithm for Weather-Related Cough Management

1. Start with non-pharmacological approaches: honey and lemon mixtures, adequate hydration 1, 2
2. If additional relief is needed, use dextromethorphan at appropriate doses (30-60 mg) 1, 4, 3
3. For quick but brief relief, consider menthol inhalation 1, 2
4. For nighttime cough disrupting sleep, consider first-generation antihistamines 1, 5
5. If cough persists beyond 3 weeks or warning signs develop, seek medical attention 1, 4

Common Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan that may not provide adequate relief 1, 4
• Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects 1, 4
• Overlooking the need for adequate hydration, which is essential for managing weather-related cough 2, 6
• Failing to recognize when a seemingly simple weather-related cough requires medical attention 2, 4