Treatment of Dry Cough in Adults
For adults with dry cough, simple home remedies like honey and lemon should be used as first-line treatment, with dextromethorphan being the preferred pharmacological option due to its efficacy and better safety profile compared to other antitussives. 1, 2
First-Line Approach
- Simple home remedies such as honey and lemon are the simplest, cheapest, and often effective first-line treatment for dry cough 1
- Voluntary suppression of cough may be sufficient to reduce cough frequency through central modulation of the cough reflex 1
- Smoking cessation should be encouraged for smokers as it is accompanied by significant remission in cough symptoms 3
Pharmacological Options
Recommended First-Line Medications
- Dextromethorphan is a non-sedating opiate that effectively suppresses the cough reflex 1, 4
- Maximum cough suppression occurs at 60 mg of dextromethorphan, which is higher than typical over-the-counter doses 1, 2
- Dextromethorphan has been shown to be effective in meta-analysis for acute cough 1, 5
- Dextromethorphan should be used with caution as some preparations contain additional ingredients like paracetamol 1, 4
Other Helpful Options
- Menthol suppresses cough reflex when inhaled, providing acute but short-lived relief 1, 2
- First-generation antihistamines with sedative properties can suppress cough and are particularly useful for nocturnal cough 1, 2, 6
Not Recommended
- Codeine and pholcodine have no greater efficacy than dextromethorphan but have a much greater adverse side effect profile (drowsiness, nausea, constipation) 1, 2, 7
Approach Based on Cough Duration and Type
For Acute Viral Cough
- Start with honey and lemon mixtures 2, 8
- If additional relief is needed, use dextromethorphan at appropriate doses (30-60 mg) 2, 5
- For nighttime cough, consider first-generation antihistamines 2, 6
For Persistent Cough
- Consider underlying causes such as GORD (gastroesophageal reflux disease), which may require intensive acid suppression with proton pump inhibitors for at least 3 months 3
- For cough associated with upper airway symptoms, a trial of topical corticosteroid is recommended 3
- For postinfectious cough, consider inhaled ipratropium before central antitussives 2
Special Considerations
- Cough with increasing breathlessness should be assessed for asthma 1
- Cough with fever, malaise, purulent sputum may indicate serious lung infection 2
- Significant hemoptysis or possible foreign body inhalation requires specialist referral 1
- Bronchial provocation testing should be performed in patients with chronic cough and normal spirometry without an obvious cause 3
Common Pitfalls to Avoid
- Using subtherapeutic doses of dextromethorphan that may not provide adequate relief 2, 9
- Failing to consider GORD as a cause for persistent cough, which is a common reason for treatment failure 3
- Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects 2, 7
- Not recognizing that reflux-associated cough may occur without gastrointestinal symptoms 3