How to treat a dry cough?

Treatment of Dry Cough

Start with honey and lemon mixtures as your first-line approach, then escalate to dextromethorphan 30-60 mg if needed for symptomatic relief. 1, 2

First-Line Treatment Strategy

Begin with simple home remedies before moving to pharmacological options, as most acute dry coughs are viral and self-limiting 3, 2:

• Honey and lemon mixtures are the simplest, cheapest, and often effective first approach 1, 2
• Voluntary cough suppression techniques may be sufficient to reduce cough frequency through central modulation of the cough reflex 2
• These measures work for 1-3 weeks in most viral upper respiratory infections 2

Pharmacological Treatment

Dextromethorphan (Preferred Agent)

Dextromethorphan is the recommended first-line antitussive due to superior safety profile compared to opioid alternatives 1, 2:

• Dose 30-60 mg for optimal cough suppression, as standard over-the-counter dosing is often subtherapeutic 1, 2
• Maximum cough reflex suppression occurs at 60 mg with prolonged effect 2
• FDA-approved to temporarily relieve cough due to minor throat and bronchial irritation 4
• Exercise caution with higher doses as some preparations contain additional ingredients like paracetamol 2

Alternative Options

Menthol inhalation provides quick but brief relief 1, 2:

• Suppresses cough reflex when administered by inhalation 1
• Effect is acute and short-lived 1, 2
• Can be prescribed as menthol crystals or proprietary capsules 2

First-generation sedating antihistamines are particularly useful for nocturnal cough 1, 2:

• Suppress cough through sedative properties 1
• Best reserved for nighttime use when cough disrupts sleep 2

What NOT to Use

Avoid codeine and pholcodine as they have no greater efficacy than dextromethorphan but significantly more side effects 1, 2, 5:

• Codeine has no efficacy advantage over dextromethorphan 1
• Both carry substantial adverse effect profiles 2

When Cough Persists Beyond 3 Weeks

Seek medical evaluation if any of the following are present 3, 1, 2:

• Coughing up blood 3, 2
• Breathlessness 3, 2
• Prolonged fever and feeling unwell 3, 2
• Pre-existing conditions (COPD, heart disease, diabetes, asthma) 2
• Recent hospitalization 3, 2
• Symptoms persisting beyond 3 weeks 3, 1

For Postinfectious Cough (Persisting After Viral Infection)

Try inhaled ipratropium first before central antitussives 1, 2:

• Inhaled ipratropium is the first-line approach for postinfectious cough 1, 2
• For severe paroxysms, consider prednisone 30-40 mg daily for a short period after ruling out other causes 1, 2
• If pertussis is suspected, macrolide antibiotics are indicated 1

For Unexplained Chronic Cough (Beyond 8 Weeks)

Multimodality speech pathology therapy should be the initial non-pharmacological approach 3, 2:

• Includes education, cough suppression techniques, vocal hygiene training, and psychoeducational counseling 3
• Has been shown to decrease objective cough frequency and improve quality of life 3

Gabapentin can be considered for refractory cases 3, 2:

• Start at 300 mg once daily, escalating to maximum 1,800 mg daily in divided doses 2
• Reassess risk-benefit profile at 6 months before continuing 2

Critical Pitfalls to Avoid

Do not use subtherapeutic doses of dextromethorphan (less than 30 mg), as they may not provide adequate relief 1

Do not prescribe antitussives for productive cough where clearance of secretions is beneficial 1

Do not use antibiotics for viral dry cough, even if you feel unwell—they won't help 3

Stop smoking immediately as it significantly worsens cough and delays resolution 2