What is the efficacy of honey versus expectorant (mucolytic) syrup in relieving cough in adults?

From the Guidelines

For adults with a cough, honey is generally recommended as a first-line treatment due to its natural antimicrobial properties and minimal side effects, whereas the provided evidence does not support the routine use of pharmacologic treatments like expectorant syrups for chronic cough due to stable chronic bronchitis 1.

When considering the management of cough in adults, it's essential to differentiate between acute and chronic coughs, as well as their underlying causes. The evidence provided focuses on chronic cough due to stable chronic bronchitis, highlighting the lack of support for routine pharmacologic treatments, including expectorants, for relieving cough per se until they are proven safe and effective 1.

Key points to consider in the management of cough include:

• The importance of identifying and addressing underlying causes, such as smoking and exposure to environmental pollutants, which are risk factors for chronic bronchitis and chronic obstructive pulmonary disease (COPD) 1.
• The role of non-pharmacologic interventions, such as smoking cessation, which can significantly impact the severity and frequency of cough in patients with chronic lung disease 1.
• The potential benefits of natural remedies like honey, which, although not directly addressed in the provided evidence, have been suggested in other contexts for their soothing effects on the throat and potential to reduce cough severity.

In the absence of strong evidence supporting the use of expectorant syrups for chronic cough due to stable chronic bronchitis, and considering the potential benefits and minimal risks associated with honey, honey can be considered a preferable initial approach for managing uncomplicated coughs in adults, with the caveat that persistent, severe, or worsening symptoms should prompt a healthcare consultation to rule out underlying conditions requiring medical intervention.

From the Research

Comparison of Honey and Expectorant Syrup for Coughing in Adults

• There are no direct studies comparing honey and expectorant syrup for coughing in adults in the provided evidence.
• However, the effectiveness of guaifenesin, an expectorant, in relieving cough symptoms has been studied 2, 3.
• Guaifenesin is thought to increase hydration and decrease viscosity of mucus, leading to improved clearance of accumulated secretions from the upper and lower airway 3.
• The use of guaifenesin in patients with stable chronic bronchitis has been reviewed, and it is considered a safe and effective expectorant for the treatment of mucus-related symptoms 2, 3.
• On the other hand, honey has been traditionally used as a cough suppressant, but its effectiveness has not been directly compared to expectorant syrup in the provided evidence.
• Chronic cough in adults can have multiple causes, including upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), and making an accurate diagnosis is important for effective treatment 4.

Expectorant Syrup (Guaifenesin) Mechanism and Efficacy

• Guaifenesin acts by loosening mucus in the airways and making coughs more productive 2.
• It is used for relief of wet cough and chest congestion due to the common cold, and remains the only legally marketed expectorant in the US (per OTC Monograph) 2.
• Clinical pharmacology and patient studies support the clinical utility of guaifenesin in respiratory conditions where mucus hypersecretion is prevalent: acute upper respiratory tract infections (URTIs), stable chronic bronchitis, and possibly rhinosinusitis 2.

Diagnosis and Management of Cough

• Chronic cough is common and impactful, frustrating both patients and clinicians, and making an accurate diagnosis is important for effective treatment 4.
• The three most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease (GERD), but there are often multiple causes involved 4.
• Minimal investigations after history, physical exam, travel history, and drug history include a chest radiograph and spirometry, and empirical trial of therapy with inhaled corticosteroids is reasonable if there is evidence of eosinophilic inflammation 4.