From the Guidelines
For adults with persistent coughing, honey is the preferred initial treatment due to its natural soothing properties and lower risk of side effects, as suggested by the NICE guidelines for managing COVID-19 symptoms in the community 1. When considering the management of persistent coughing in adults, it's essential to differentiate between dry, irritating coughs and productive, mucus-filled coughs.
- For dry coughs, honey can be an effective option, with a recommended dose of a teaspoon of honey as needed, due to its ability to coat the throat and reduce irritation.
- Expectorant syrups, such as those containing codeine or morphine, are generally reserved for more severe cases where cough suppression is necessary, but their use should be cautious and guided by specific clinical scenarios, such as distressing cough, and with careful consideration of potential side effects and contraindications, as outlined in the NICE guidelines 1. Key considerations in the choice between honey and expectorant syrups include the type of cough, the presence of underlying conditions such as chronic bronchitis or bronchiectasis, and the potential for side effects.
- Honey is generally well-tolerated and can be used in conjunction with other remedies like staying hydrated and using a humidifier to help soothe the throat and thin out mucus.
- Expectorants, on the other hand, may be more appropriate for coughs that are productive, meaning they bring up mucus, but their use should be guided by the specific clinical context and with awareness of potential side effects like nausea or drowsiness, as indicated in the study 1.
From the Research
Comparison of Honey and Expectorant Syrup for Persistent Coughing in Adults
- Honey has been found to be an effective treatment for persistent post-infectious cough (PPC) when combined with coffee, as shown in a study published in 2013 2.
- The study compared the therapeutic effects of honey plus coffee, systemic steroid, and guaifenesin in 97 adults with PPC, and found that the honey plus coffee group had a significant reduction in cough frequency.
- Expectorant syrups, such as those containing guaifenesin, are commonly used to relieve wet cough and chest congestion, and have been shown to be safe and effective in adults 3.
- However, the effectiveness of expectorant syrups for persistent coughing in adults is not well established, and more research is needed to determine their efficacy in this population.
- Chronic cough in adults can be caused by a variety of factors, including upper airway cough syndrome, gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis, and treatment should be tailored to the underlying cause 4, 5.
- Recent guidelines recommend a thorough workup and evaluation of underlying conditions, and suggest that novel therapeutic targets, such as those targeting specific channel receptors, may be effective in treating chronic cough 6.
Key Findings
- Honey plus coffee was found to be the most effective treatment modality for PPC in a randomized controlled trial 2.
- Guaifenesin has a well-established and favorable safety and tolerability profile in adult populations, and is considered a safe and effective expectorant for the treatment of mucus-related symptoms in acute upper respiratory tract infections and stable chronic bronchitis 3.
- Chronic cough in adults is a complex condition that requires a multidisciplinary approach to diagnosis and treatment, and may involve the use of neuromodulators, speech pathology therapy, and other treatments 4, 5.