First Aid Treatment for Seasonal Cold and Cough
For adults with seasonal cold and cough, start with honey and lemon mixtures as the simplest and most effective first approach, followed by dextromethorphan 30-60 mg for persistent dry cough, or first-generation antihistamine/decongestant combinations for cough with post-nasal drip. 1, 2
Immediate First-Line Treatments
Non-Pharmacological Approaches (Start Here)
- Honey and lemon mixtures are as effective as most medications and should be your first choice 1, 2
- Adequate hydration helps thin secretions and makes coughs more productive 1
- Voluntary cough suppression techniques can reduce cough frequency without medication 1, 2
- Hand hygiene to prevent spread to others 3
For Dry, Non-Productive Cough
- Dextromethorphan 30-60 mg provides optimal cough suppression (note: standard over-the-counter doses of 15-30 mg are often subtherapeutic) 1, 2, 4
- Menthol inhalation (crystals, lozenges, or vapor rubs) provides quick but short-lived relief 1, 2
- First-generation antihistamines with sedative properties work well for nighttime cough 1, 2
For Wet, Productive Cough
- Guaifenesin helps loosen phlegm and thin bronchial secretions 5
- Do NOT suppress productive cough as clearance of secretions is beneficial 2
For Nasal Congestion and Post-Nasal Drip
- First-generation antihistamine/decongestant combinations (like pseudoephedrine with brompheniramine) are effective for cough caused by post-nasal drip 6
- Nasal decongestants for short-term use only (avoid prolonged use due to rebound congestion) 7
- Nasal saline irrigation reduces symptoms 3
For Associated Symptoms
- NSAIDs (ibuprofen or naproxen) for headache, body aches, and fever 6, 7
- Zinc lozenges (≥75 mg/day of zinc acetate or gluconate) started within 24 hours of symptom onset can reduce cold duration 7, 3
What NOT to Use
Ineffective Treatments
- Newer non-sedating antihistamines are ineffective for common cold 6, 7
- Intranasal corticosteroids provide no benefit 7
- Antibiotics are not helpful for viral colds, even with colored phlegm 1
Avoid Due to Safety Concerns
- Codeine or pholcodine have no greater efficacy than dextromethorphan but significantly more side effects (drowsiness, nausea, constipation, dependence) 1, 2
- Over-the-counter cough and cold medications should NOT be used in children under 4 years of age 6
Practical Treatment Algorithm
Day 1-2 of symptoms:
- Start honey and lemon mixtures 1, 2
- Begin zinc lozenges (≥75 mg/day) within 24 hours for maximum benefit 7
- Use NSAIDs for fever, headache, body aches 6, 7
- Add dextromethorphan 30-60 mg if dry cough is bothersome 1, 2
- Add first-generation antihistamine/decongestant if post-nasal drip is present 6
Day 3-7:
- Continue effective treatments
- Treatment started after day 2 is generally less effective 8
- Most symptoms improve by day 7-14 6
For nighttime cough specifically:
- First-generation sedating antihistamines are particularly suitable 1, 2
- Menthol vapor rubs can be helpful 3
Important Caveats and Red Flags
Seek Medical Attention If:
- Coughing up blood 1
- Experiencing breathlessness 1
- Prolonged fever with feeling unwell 1
- Underlying conditions (COPD, heart disease, diabetes, asthma) 1
- Symptoms persist beyond 3 weeks 1
- Green or yellow sputum suggesting bacterial infection 9
Medication Safety
- Be cautious with combination products containing multiple active ingredients - some dextromethorphan preparations contain paracetamol, risking overdose at higher doses 1, 2
- Check for drug interactions if patient has pre-existing conditions (hypertension, stomach problems, asthma) 9
- Two tablets at first dosing are more effective than one for combination products 8
- Decongestants should only be used short-term to avoid rebound congestion 7