What are the treatment options for a cough?

Treatment Options for Cough

For most short-term coughs, home remedies like honey and lemon are recommended as first-line treatment, with dextromethorphan-containing medications being the most effective pharmacological option for symptomatic relief. 1, 2, 3

Initial Assessment and Management

• Most short-term coughs are due to viral infections and don't require antibiotics, even if producing phlegm 1
• Home remedies should be tried first:
  • Honey and lemon mixtures provide effective symptomatic relief 2, 3
  • Adequate hydration helps thin secretions for productive coughs 2
  • Simple voluntary cough suppression may reduce frequency 2

Pharmacological Options

First-Line Medications

• Dextromethorphan is the recommended first-line antitussive:

  • Non-sedating with superior safety profile compared to opioids 2, 3
  • Optimal dosing at 60mg provides maximum cough reflex suppression 2, 3
  • Should not be used with MAOIs or in patients with chronic productive cough 4

• Menthol lozenges or vapor:

  • Provides acute, short-lived cough suppression 1, 2
  • Works through cold and menthol sensitive receptors 2
  • Can be prescribed as menthol crystals or proprietary capsules/lozenges 2

For Productive Cough

• Guaifenesin helps loosen phlegm and thin bronchial secretions 5
• Antitussives should generally be avoided for productive cough as clearance of secretions is beneficial 3

Second-Line Options

• First-generation antihistamines with sedative properties:
  • Particularly suitable for nocturnal cough due to sedating effect 2, 3
  • Often combined with dextromethorphan for enhanced effect 6

Not Recommended

• Codeine or pholcodine have no greater efficacy than dextromethorphan but have worse side effect profiles 2, 3, 7
• Antibiotics are not helpful for cough due to viral infections 1

When to Seek Medical Attention

Consult a doctor if you experience any of the following:

• Coughing up blood 1
• Breathlessness 1
• Prolonged fever and feeling unwell 1
• Pre-existing medical conditions like COPD, heart disease, diabetes, or asthma 1
• Recent hospitalization 1
• Symptoms persisting for more than three weeks 1, 8

Special Considerations

• For severe paroxysms of postinfectious cough, prednisone 30-40mg daily for a short period may be considered 3
• Inhaled ipratropium may be tried before central antitussives for postinfectious cough 3
• If pertussis is suspected, macrolide antibiotics are indicated 1, 3
• Stop smoking to prevent worsening of cough symptoms 1, 2
• Practice proper cough hygiene (using handkerchief, hand washing) to prevent spreading infection 1

Treatment Algorithm

1. Try honey and lemon mixtures first 2, 3
2. If additional relief needed, use dextromethorphan 30-60mg 2, 3
3. For productive cough, consider guaifenesin to help loosen secretions 5
4. For quick but temporary relief, try menthol inhalation 2, 3
5. For nighttime cough, consider first-generation antihistamines 2, 3
6. If cough persists beyond 3 weeks, seek medical evaluation for chronic cough causes 1, 8