Aspirin Should Not Be Used to Treat Cough
Aspirin is not recommended for the treatment of cough and is not mentioned in any evidence-based guidelines as an effective antitussive agent. In fact, aspirin can paradoxically cause cough and bronchospasm in susceptible individuals, particularly those with asthma or aspirin hypersensitivity 1, 2, 3.
Why Aspirin Is Not Appropriate for Cough
Lack of Evidence for Efficacy
- Major clinical practice guidelines from the American College of Chest Physicians (ACCP) and Thorax do not include aspirin among recommended cough treatments 4.
- For acute cough from the common cold, the only nonsteroidal anti-inflammatory drug with any recommendation is naproxen (not aspirin), and this is for symptomatic relief of cold symptoms generally, not specifically for cough suppression 4.
- Recommended cough suppressants include ipratropium bromide, codeine, dextromethorphan, and peripheral agents like levodropropizine—but not aspirin 4.
Aspirin Can Actually Cause Cough
- Aspirin-induced cough is a recognized phenomenon, occurring even without bronchoconstriction in some patients 1.
- Between 8-20% of adult asthmatics experience bronchospasm following aspirin ingestion, often accompanied by productive cough, rhinorrhoea, and dyspnoea within 20 minutes to 3 hours 2.
- Aspirin-exacerbated respiratory disease (AERD) manifests as asthma, rhinosinusitis, nasal polyps, and sensitivity to aspirin and other COX-1 inhibitor NSAIDs 3.
Special Concerns in Patients with Neurological/Musculoskeletal History
- Elderly patients with complicated medical histories are more prone to adverse effects of salicylates, including gastrointestinal bleeding, renal insufficiency, asthma, and CNS toxicity 5.
- In patients with neuromuscular impairment specifically, protussive pharmacologic agents are ineffective and should not be prescribed 4.
What Should Be Used Instead
For Acute Cough from Common Cold
- First-generation antihistamine/decongestant combinations are strongly recommended unless contraindicated 4.
- Naproxen (not aspirin) may provide symptomatic relief for cold symptoms 4.
- Newer nonsedating antihistamines should not be used as they are ineffective 4.
For Chronic Cough
- Identify and treat the underlying cause: asthma, GERD, ACE inhibitor use, smoking, or upper airway pathology 4.
- Stop ACE inhibitors immediately if the patient is taking them—this is a common and reversible cause 4.
- For GERD-related cough, use intensive acid suppression with proton pump inhibitors and alginates for at least 3 months 4, 6.
- For upper airway symptoms, use topical corticosteroids 4, 6.
For Cough Suppression When Needed
- Ipratropium bromide is the recommended agent for cough suppression (Grade A recommendation) 4.
- Codeine or dextromethorphan for chronic bronchitis (Grade B recommendation) 4.
- Central cough suppressants have limited efficacy for URI-related cough and are not recommended 4.
Critical Pitfall to Avoid
Do not use aspirin in patients with asthma, nasal polyps, or chronic rhinitis, as they are at significantly higher risk for aspirin-induced bronchospasm and respiratory reactions 2, 3. The only specific indication where intermediate-dose aspirin (500 mg daily, not 100 mg) has shown benefit is in suppressing ACE inhibitor-induced cough, but this is a very specific scenario and the patient should simply discontinue the ACE inhibitor instead 7.