What are effective treatments for cough?

Effective Treatments for Cough

For symptomatic relief of cough, honey and lemon mixtures are recommended as an effective home remedy, while central cough suppressants like codeine and dextromethorphan provide short-term relief specifically in chronic bronchitis but are NOT recommended for acute cough due to common cold. 1, 2

Treatment Based on Cough Type and Etiology

Acute Cough (Common Cold/Upper Respiratory Infection)

• Over-the-counter combination cold medications are NOT recommended until proven effective in randomized controlled trials, with the exception of older antihistamine-decongestant combinations 2
• Zinc preparations are NOT recommended for acute cough due to common cold 2
• Albuterol is NOT recommended for acute cough not due to asthma 2
• Dextromethorphan temporarily relieves cough due to minor throat and bronchial irritation from common cold or inhaled irritants 3, 4
• Honey and lemon mixtures provide symptomatic relief and are recommended by the British Thoracic Society 1

Chronic Bronchitis

• Central cough suppressants (codeine and dextromethorphan) are recommended for short-term symptomatic relief with fair evidence and intermediate benefit 2
• Ipratropium bromide is the ONLY inhaled anticholinergic recommended for cough suppression in chronic bronchitis with substantial benefit 5, 2
• Peripheral cough suppressants (levodropropizine and moguisteine) show the highest level of benefit and are recommended with Grade A evidence, especially in children 5, 6
• Long-acting β-agonist combined with inhaled corticosteroid should be offered to control chronic cough in stable patients 2
• Mucolytic agents are NOT consistently effective for ameliorating cough in bronchitis and are not recommended 2
• Expectorants are NOT effective and should not be used 2
• Theophylline should NOT be used for acute exacerbations 2

Chronic Cough Management Algorithm

First, identify and treat the underlying cause systematically:

1. Discontinue ACE inhibitors immediately if present, as they commonly cause persistent dry cough 1, 7
2. Advise smoking cessation - symptoms can resolve within 4 weeks 1
3. Obtain chest radiograph to rule out serious pathology 1

Then treat the three most common causes sequentially:

• Upper Airway Cough Syndrome (UACS): First-generation antihistamine/decongestant combination as first-line therapy 1, 7
• Asthma/Non-asthmatic Eosinophilic Bronchitis (NAEB): Inhaled corticosteroids combined with long-acting β-agonists for asthma; inhaled corticosteroids alone for NAEB 1, 2
• Gastroesophageal Reflux Disease (GERD): High-dose proton pump inhibitors with dietary modifications; add prokinetic therapy if inadequate response 1, 7

Refractory Chronic Cough

• Low-dose morphine is recommended for idiopathic chronic cough refractory to other treatments 1
• Consider referral to cough specialist if cough persists despite sequential trials of therapy 1

Critical Pitfalls to Avoid

• Do NOT rely solely on cough characteristics for diagnosis - they have limited diagnostic value 1
• Do NOT treat only one potential cause - multiple factors contribute to chronic cough in 59% of cases, requiring sequential and additive therapy 7
• Do NOT assume nocturnal cough indicates psychogenic or habit cough - this is diagnostically unreliable 7
• Do NOT use protussive pharmacologic agents in patients with neuromuscular impairment - they are ineffective 2

Special Populations

Cystic Fibrosis

• Amiloride is recommended to increase cough clearance in adults 2
• Recombinant DNase is NOT recommended to increase cough clearance despite improving spirometry 2
• Positive expiratory pressure is recommended over conventional chest physiotherapy 2

Neuromuscular Disease

• Mechanical cough assist devices are recommended to prevent respiratory complications 2
• Manually assisted cough should be considered to reduce respiratory complications 2