What treatment is recommended for a dry cough?

From the Guidelines

For a dry cough, the first line of treatment should be simple non-drug measures such as taking a teaspoon of honey, as recommended by the most recent and highest quality study 1. This approach is supported by the study published in the BMJ in 2020, which suggests that honey can be an effective treatment for cough symptoms 1. Some key points to consider when treating a dry cough include:

• Avoiding cough suppressants in chronic bronchitis and bronchiectasis, as they can cause sputum retention 1
• Using codeine linctus or codeine phosphate tablets as a second-line treatment, with a dose of 15-30 mg every 4 hours as required, up to four doses in 24 hours 1
• Considering morphine sulfate oral solution as an alternative, with a dose of 2.5-5 mg when required every 4 hours 1 It's also important to note that other studies, such as those published in Chest in 2006, recommend against the use of certain medications, such as ipratropium bromide, for cough suppression in patients with chronic bronchitis or upper respiratory infection 1. However, these studies are older and lower in quality compared to the BMJ study, and therefore should not be considered as the primary source of guidance for treating dry cough. Overall, the most effective treatment for dry cough will depend on the individual patient's symptoms and medical history, and should be guided by the most recent and highest quality evidence available.

From the FDA Drug Label

Purpose Cough suppressant Uses temporarily relieves: cough due to minor throat and bronchial irritation as may occur with a cold or inhaled irritants your cough to help you sleep helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and makes cough more productive For a dry cough, consider giving dextromethorphan (PO), a cough suppressant 2, or codeine (PO), which can help relieve cough due to minor throat and bronchial irritation 3.

• Dextromethorphan may be used to suppress the cough.
• Codeine can help relieve cough and may be used to help sleep.

From the Research

Treatment Options for Dry Cough

• Antitussive preparations, which are available as combinations of codeine or dextromethorphan with antihistamines, decongestants, and expectorants, can provide effective symptomatic relief of dry or non-productive cough 4.
• First-generation antihistamines like chlorpheniramine and centrally acting opioid derivatives like codeine are often used alone or in combination in the management of nonspecific cough 4.
• Sedation caused by these medications is valuable, particularly if the cough is disturbing the sleep 4.

Inhaler Options for Respiratory Conditions

• Inhaled medication is the cornerstone of the pharmacological treatment of patients with asthma and COPD, with corticosteroids (ICS) and bronchodilators being the major two classes of inhaled medication 5.
• The correct use of inhalers is not guaranteed, and patients often make mistakes when using pMDIs and DPIs, despite repeated instructions 5.
• A better matching between patient and device could be accomplished if the physician is aware of patient characteristics, the class of medication indicated, where in the lung the medication should be delivered, and how this can be best achieved by a given device in this specific patient 5.

Effectiveness of Inhaled Corticosteroids

• Inhaled corticosteroid (ICS) treatment can decrease the risk of exacerbation in patients with asthma-COPD overlap, and a blood eosinophil count of ≥300 cells/μL can predict the response to ICS treatment 6.
• ICS treatment was associated with less exacerbation in patients with asthma-COPD overlap, according to the specialists' diagnoses and the GINA/GOLD criteria 6.

Choosing the Right Inhaler

• Effective management of chronic respiratory disorders such as chronic obstructive pulmonary disease and asthma necessitates that patients inhale their medication, and numerous types of inhalers are currently available with distinct advantages and disadvantages 7.
• The choice of inhaler may be influenced by many factors, including inhaler attributes, patient characteristics and preferences, dosing regimen, clinical setting, and support available for both patients and healthcare providers 7.

Safety and Effectiveness of Inhaled Bronchodilators and Corticosteroids

• Long-acting beta2-agonist (LABA) is associated with decreased risk of myocardial infarction, and the combination therapy of ICS/LABA appears to reduce the risk of death or hospitalization in patients with asthma-COPD overlap 8.
• However, due to a lack of data, exacerbations, fractures, and nontuberculous mycobacterial pulmonary disease outcomes were not meta-analyzed 8.