From the Guidelines
In the emergency room setting, the most effective cough medication for symptomatic relief is likely to be an opioid derivative, such as codeine or hydrocodone, due to their strong evidence base in managing cough among patients with lung cancer, as suggested by the study published in Chest in 2017 1. When considering the management of cough in the emergency room, it's essential to identify the underlying cause of the cough and address it accordingly. However, for symptomatic relief, the following options can be considered:
- For dry coughs, codeine or hydrocodone may be used, with codeine being less preferred due to its greater side effect profile compared to other opioids, as noted in the study published in Chest in 2017 1.
- For productive coughs, guaifenesin (200-400 mg every 4 hours) may help loosen mucus.
- If the cough is due to allergies or postnasal drip, antihistamines like diphenhydramine (25-50 mg) might be beneficial.
- For coughs associated with asthma or reactive airway disease, albuterol via nebulizer or inhaler could be appropriate. It's crucial to understand that in the ER, treating the underlying cause (infection, asthma, heart failure, etc.) is the primary goal rather than simply suppressing the cough symptom. Cough medications are generally considered adjunctive therapy while the primary condition is being addressed. The study published in BMJ in 2020 1 provides guidance on managing COVID-19 symptoms, including cough, in the community, and suggests the use of codeine linctus or codeine phosphate tablets for distressing cough. However, the study published in Chest in 2017 1 provides more specific guidance on the management of cough in patients with lung cancer, and its recommendations should be prioritized in this context.
From the FDA Drug Label
Purpose Cough suppressant Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant The best cough medication to give someone in the ER is dextromethorphan (PO), a cough suppressant 2 2.
- Key benefits: 12 Hour Cough Relief, Alcohol-free
- Important consideration: Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions
From the Research
Cough Medication Options
- Guaifenesin is a mucoactive drug that acts by loosening mucus in the airways and making coughs more productive 3
- 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 3
- Guaifenesin has a well-established and favorable safety and tolerability profile in adult and pediatric populations 3
Effectiveness in Respiratory Conditions
- Guaifenesin is considered as a safe and effective expectorant for the treatment of mucus-related symptoms in acute upper respiratory tract infections (URTIs) and stable chronic bronchitis 3, 4
- Clinical efficacy has been demonstrated most widely in chronic respiratory conditions, where excess mucus production and cough are more stable symptoms 3
- A case report showed improved lung function and quality of life following daily use of guaifenesin/dextromethorphan in a patient with chronic obstructive pulmonary disease (COPD) 5