What are the recommended treatments for a non-severe cough in adults and children?

Home Cough Remedies for Non-Severe Cough

Start with honey and lemon as first-line treatment for both adults and children with acute cough, as this simple home remedy is as effective as many pharmacological options without any adverse effects. 1, 2, 3

First-Line Approach: Non-Pharmacological

• Honey and lemon mixture is the simplest, cheapest, and most effective first-line treatment with evidence of patient-reported benefit and should be tried before any medications 1, 2, 3
• Most acute viral coughs are self-limiting and resolve within 1-3 weeks without requiring prescribed medication, making watchful waiting appropriate 1, 3
• Voluntary cough suppression through central modulation of the cough reflex may be sufficient to reduce cough frequency in some patients 1, 2
• Humidified air and adequate fluid intake are useful supportive measures without adverse side effects 4

When Pharmacological Treatment is Needed

For Dry Cough in Adults

• Dextromethorphan is the preferred pharmacological agent due to superior efficacy and better safety profile compared to codeine-based alternatives 1, 2, 3, 5
• The effective dose is 60 mg for maximum cough suppression, which is higher than standard over-the-counter dosing 1, 2
• Standard OTC dosing (10-15 mg three to four times daily) is often subtherapeutic and may not provide adequate relief 1, 2
• Maximum daily dose should not exceed 120 mg 2
• Exercise caution with combination preparations that may contain acetaminophen or other ingredients when using higher doses 1, 2

For Nocturnal Cough

• First-generation sedating antihistamines (such as diphenhydramine) can suppress cough and are particularly useful when cough disrupts sleep due to their sedative properties 1, 2
• The sedation effect is the primary benefit for nighttime use 1

For Quick Temporary Relief

• Menthol inhalation (as crystals or proprietary capsules) suppresses cough reflex acutely but provides only short-lived relief 1, 2

For Productive Cough

• Guaifenesin helps loosen phlegm and thin bronchial secretions to make coughs more productive 6
• This is appropriate when the goal is to facilitate clearance rather than suppress the cough 6

Medications to AVOID

• Codeine and pholcodine should NOT be used as they have no greater efficacy than dextromethorphan but have significantly more adverse effects including drowsiness, nausea, constipation, and physical dependence 1, 2, 3
• Antibiotics have no role in simple viral cough and should not be prescribed 3
• Newer nonsedating antihistamines are ineffective against cough 4

Critical Pitfalls to Avoid

• Using subtherapeutic doses of dextromethorphan (less than 60 mg) may result in inadequate cough suppression 1, 2, 3
• Suppressing productive cough in conditions like pneumonia or bronchiectasis where clearance is essential 1
• Prescribing codeine-based products which offer no efficacy advantage but increased side effects 1, 2, 3

Red Flags Requiring Immediate Medical Evaluation

• Hemoptysis (coughing up blood) 1, 3
• Increasing breathlessness or tachypnea 1, 3
• High fever with tachycardia and abnormal chest examination suggesting pneumonia 1, 3
• Cough persisting beyond 3 weeks requires full diagnostic workup rather than continued home remedies 2, 3
• Purulent sputum with fever and malaise suggesting serious lung infection 1, 3

Special Considerations for Children

• Honey provides modest decrease in cough frequency and severity compared to dextromethorphan or no treatment in children 7
• Dextromethorphan effectiveness has not been demonstrated in children and adolescents 4
• Antihistamines, decongestants, and combinations do not relieve cough better than placebo in children 7