What is the most effective treatment for acute cough?

Most Effective Treatment for Acute Cough

For acute cough, simple home remedies like honey and lemon are recommended 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

• Acute viral cough is typically benign and often does not require prescribed medication 3, 1
• Simple home remedies such as honey and lemon are the simplest, cheapest, and often effective first-line treatment 3, 1, 2
• Voluntary suppression of cough may be sufficient to reduce cough frequency through central modulation of the cough reflex 3, 1

Pharmacological Options (When Needed)

Dextromethorphan

• Dextromethorphan is a non-sedating opiate that effectively suppresses the cough reflex 3, 1, 4
• Maximum cough reflex suppression occurs at 60 mg and can be prolonged 3, 1, 2
• Standard over-the-counter dosing is often subtherapeutic 2
• Use with caution as some preparations contain additional ingredients like paracetamol 3, 1

Menthol

• Menthol suppresses cough reflex when inhaled 3, 2
• Can be prescribed as menthol crystals or proprietary capsules 3
• Effect is acute and short-lived 3, 2

Antihistamines

• First-generation antihistamines with sedative properties can suppress cough 3, 2
• Particularly useful for nocturnal cough due to sedative effects 3, 2, 5

Expectorants

• Guaifenesin helps loosen phlegm and thin bronchial secretions to make coughs more productive 6
• Evidence for effectiveness is mixed, with some studies showing benefit and others showing no difference from placebo 7, 8

Not Recommended

• Codeine and pholcodine have no greater efficacy than dextromethorphan 3, 2
• These opiates have significant adverse side effect profiles (drowsiness, nausea, constipation, physical dependence) 3, 2, 5
• Not recommended due to poor benefit-to-risk ratio 2, 9

Practical Algorithm for Acute Cough Management

1. For benign viral cough:

   • Start with non-pharmacological approaches: honey and lemon mixtures 1, 2
   • Try voluntary cough suppression techniques 1, 2

2. If additional relief is needed:

   • Use dextromethorphan at appropriate doses (30-60 mg) 1, 2, 9
   • For quick but temporary relief, consider menthol inhalation 3, 2

3. For nighttime cough disrupting sleep:

   • Consider first-generation antihistamines with sedative properties 3, 2, 5

4. For productive cough:

   • Consider guaifenesin to help loosen phlegm 6, 7

Special Considerations

• Cough with increasing breathlessness should be assessed for asthma or anaphylaxis 3
• Cough with fever, malaise, purulent sputum may indicate serious lung infection 3
• Significant hemoptysis or possible foreign body inhalation requires specialist referral 3, 2

Common Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan that may not provide adequate relief 1, 2
• Prescribing codeine-based antitussives which have no efficacy advantage but increased side effects 3, 2, 5
• Failing to recognize when cough may be a symptom of a more serious condition requiring specific treatment 3, 2
• Not considering that persistent cough may have underlying causes such as GORD (gastroesophageal reflux disease) 1