What is the treatment for cough?

From the Guidelines

For cough treatment, start with over-the-counter options like dextromethorphan (10-30mg every 4-6 hours) for dry coughs or guaifenesin (200-400mg every 4 hours) for productive coughs, as recommended by the American College of Chest Physicians 1.

Key Considerations

• Honey (1-2 teaspoons) can soothe throat irritation, especially before bedtime, and is a simple, cost-effective option for cough relief 1.
• Staying hydrated with warm fluids and using a humidifier to moisten airways can help alleviate cough symptoms.
• For allergic coughs, try antihistamines like loratadine (10mg daily) to reduce inflammation and relieve symptoms.
• If the cough persists beyond 2-3 weeks, is accompanied by fever over 101°F, produces discolored phlegm, or causes breathing difficulty, seek medical attention as prescription medications may be needed.

Mechanism of Action

• Cough suppressants, such as dextromethorphan, work by blocking the cough reflex in the brain, reducing the frequency and intensity of coughing 1.
• Expectorants, such as guaifenesin, thin mucus to make it easier to clear from airways, providing relief from productive coughs.

Additional Relief

• Avoiding irritants like smoke and using throat lozenges can provide additional relief while your body fights the underlying cause of the cough.
• In patients with chronic bronchitis, therapy with a short-acting inhaled β-agonist, inhaled ipratropium bromide, and oral theophylline may improve cough symptoms, but the use of prophylactic antibiotics, oral corticosteroids, expectorants, postural drainage, or chest physiotherapy is not recommended 1.

From the FDA Drug Label

Uses temporarily relieves • cough due to minor throat and bronchial irritation as may occur with the common cold or inhaled irritants • the impulse to cough to help you get to sleep USES Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive.

• Dextromethorphan 2 is used to temporarily relieve cough due to minor throat and bronchial irritation.
• Guaifenesin 3 is used to help loosen phlegm and thin bronchial secretions to make coughs more productive. For cough treatment, dextromethorphan can be used to relieve the impulse to cough, while guaifenesin can be used to make coughs more productive by loosening phlegm.

From the Research

Cough Treatment Overview

• Cough can be caused by various etiologies, with four conditions accounting for most cases in adults: upper airway cough syndrome, gastroesophageal reflux disease/laryngopharyngeal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 4
• In children, cough is considered chronic if present for more than four weeks, and is most commonly caused by asthma, protracted bacterial bronchitis, and upper airway cough syndrome in children six to 14 years of age 4

Evaluation and Management

• Patients should be evaluated clinically, with spirometry if indicated, and empiric treatment should be initiated 4
• Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions 4
• Definitive treatment of cough depends on determining its precise cause and then initiating specific therapy for the underlying disorder 5

Treatment Options

• Symptomatic treatment should only be considered when the cause of cough remains unknown or when cough performs no useful function and its complications represent a potential hazard to the patient 5
• Combination cough preparations should not be prescribed 5
• Codeine, dextromethorphan, and guaifenesin are equally effective in relieving cough symptoms 6
• Gabapentin, pregabalin, and/or speech therapy may be considered for patients with refractory chronic cough 4

Current Understanding and Future Research

• There is a clinical need for new treatments specifically directed at the cough itself, and a major obstacle to the development of such therapy has been an imprecise understanding of the pathophysiological mechanisms responsible for cough 7
• A practical approach to treatment and management of cough emphasizes causes and potentiators, and requires identifying and treating all contributing factors together 8