From the Guidelines
For treating cough and phlegm, the most effective approach is to avoid respiratory irritants, such as smoking and dusty environmental exposures, as recommended by the 2020 Chest Expert Panel report 1.
Key Recommendations
- Avoidance of respiratory irritants is the most effective way to reduce or eliminate cough in patients with chronic bronchitis and persistent exposure to respiratory irritants, such as personal tobacco use, passive smoke exposure, and workplace hazards 1.
- Stay well-hydrated with 8-10 glasses of water daily to help thin secretions.
- Use a humidifier or take steamy showers to moisten airways.
- For sore throat, try warm salt water gargles (1/4 teaspoon salt in 8 ounces warm water).
- Honey (1-2 teaspoons) can soothe cough, especially before bedtime.
- Avoid irritants like smoke and dust.
- Rest your voice if needed.
Pharmacologic Therapy
- There is insufficient evidence to recommend the routine use of any pharmacologic treatments, such as antibiotics, bronchodilators, or mucolytics, as a means of relieving cough per se until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1.
- Central cough suppressants, such as codeine and dextromethorphan, are recommended for short-term symptomatic relief of coughing 1.
Non-Pharmacologic Therapy
- Non-pharmacologic treatments, such as positive end-expiratory pressure, are not suggested as a means of relieving cough per se until such treatments have been shown to be safe and effective at making cough less severe or resolve sooner 1.
When to Seek Medical Attention
- If symptoms persist beyond 10-14 days, worsen suddenly, or are accompanied by high fever, chest pain, or difficulty breathing, seek medical attention as antibiotics may be needed for bacterial infections.
- Most coughs are viral and will resolve with supportive care.
- Expectorants work by increasing airway hydration to thin mucus, while suppressants block the cough reflex in the brain when rest is needed.
From the FDA Drug Label
USES Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive.
- Guaifenesin is used to treat cough and phlegm by loosening phlegm and thinning bronchial secretions, making coughs more productive 2.
- The drug is administered orally (PO).
- Key benefits include helping to make coughs more productive by loosening phlegm and thinning bronchial secretions.
From the Research
Cough and Phlegm Treatment
- Cough is a common symptom that can be caused by various factors, including upper respiratory tract infections, gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 3.
- The treatment of cough can be either disease-specific or symptom-related, and therapeutic suppression of cough may be necessary to prevent the vicious cycle of cough 4.
- Antitussives such as dextromethorphan are commonly used to treat cough, but their efficacy has been questioned in some studies 5.
- Peripherally acting antitussives such as levodropropizine and moguisteine have shown to be effective in treating cough, especially in children 4.
- In addition to antitussives, other treatments such as gabapentin, pregabalin, and speech therapy may be necessary for patients with refractory chronic cough 3.
- A practical approach to the diagnosis and management of cough is necessary, taking into account the multifactorial nature of cough and the need to identify and treat all contributing factors 6.
- Dextromethorphan has also been shown to have anti-viral activity against influenza, and its use has been associated with reduced hospitalization rates in patients with influenza 7.
Treatment Options
- Antitussives: dextromethorphan, levodropropizine, moguisteine 5, 4
- Disease-specific therapies: treatment of underlying conditions such as gastroesophageal reflux disease, asthma, and nonasthmatic eosinophilic bronchitis 3
- Symptomatic treatments: gabapentin, pregabalin, speech therapy 3
- Anti-viral treatments: dextromethorphan for influenza 7