Ascoril LS Should Not Be Routinely Used for Upper Respiratory Tract Infections
Ascoril LS (a combination expectorant/mucolytic/bronchodilator) is not recommended for routine management of URTI-associated cough, as high-quality evidence demonstrates that expectorants, mucolytics, and bronchodilators lack consistent efficacy in acute respiratory tract infections and should not be prescribed in primary care settings. 1
Evidence Against Combination Cough Preparations in URTI
Lack of Efficacy for Individual Components
Expectorants (like guaifenesin in Ascoril) have insufficient evidence to support their use in URTI, with no clinical trials demonstrating efficacy specifically for sinusitis or upper respiratory infections 1
Mucolytics and expectorants are sold in great quantities but consistent evidence for beneficial effects is lacking in acute lower respiratory tract infections, and the same applies to URTI 1
Bronchodilators (like salbutamol in Ascoril) should not be prescribed in acute respiratory tract infections in primary care, as studies have not shown relevant beneficial effects in uncomplicated acute cough 1
The ACCP guidelines explicitly state that over-the-counter combination cold medications are not recommended until randomized controlled trials prove they are effective cough suppressants, with the exception of older antihistamine-decongestant preparations 1
What Actually Works for URTI-Associated Cough
First-generation antihistamine/decongestant combinations (containing pseudoephedrine and brompheniramine) are the only over-the-counter preparations with proven efficacy for URTI-associated cough, demonstrating rapid improvement in cough, throat clearing, and post-nasal drip compared to placebo 1
The mechanism involves reducing virus-induced post-nasal drip, which is the primary driver of cough in URTI 1
Newer "non-sedating" antihistamines are relatively ineffective in treating the common cold, making the sedating properties of first-generation antihistamines potentially important for efficacy 1
Alternative Evidence-Based Approaches
For Symptomatic Relief
NSAIDs like naproxen have been shown in randomized controlled trials to decrease cough, headache, malaise, and myalgia in experimentally induced rhinovirus common cold, supporting the role of inflammation 1
Ipratropium bromide (inhaled anticholinergic) is the only inhaled anticholinergic recommended for cough suppression in URI, though it has been primarily studied for rhinorrhea and sneezing rather than cough specifically 1, 2
For Dry, Bothersome Cough
Dextromethorphan or codeine can be prescribed when patients have a dry and frequent cough that disturbs sleep, though their efficacy in acute URTI cough is limited 1
Cough should generally be regarded as physiological when productive, helping clear mucus from the bronchial tree 1
Critical Pitfalls to Avoid
Do not confuse acute viral URTI with bacterial sinusitis or bronchitis - a diagnosis of acute bacterial sinusitis cannot be made accurately in the face of acute viral infection, as viral infection involves all nasal and sinus mucosal surfaces (viral rhinosinusitis) 1
Most URTI episodes are self-limiting and last 1-3 weeks, with the common cold being the single most common cause of acute cough caused by over 200 different viruses 1
Antibiotics have no role in uncomplicated URTI without suspicion of pneumonia or bacterial complications 1
Limited Supporting Evidence for Ascoril
While one industry-sponsored study from 2000 suggested Ascoril had better efficacy than another cough formula 3, this conflicts with multiple high-quality international guidelines from the ACCP, European Respiratory Society, and systematic reviews that consistently demonstrate lack of efficacy for combination expectorant/mucolytic/bronchodilator preparations 1, 4