What are the conservative management options for acute cough?

From the Guidelines

Conservative management of a cough should prioritize home remedies and over-the-counter medications, with a focus on soothing throat irritation and suppressing coughing, as evidenced by the study published in Thorax in 2006 1. When managing a cough conservatively, it's essential to consider the following key points:

• Adequate hydration is crucial, but the study 1 suggests that the simplest and cheapest advice may be to provide a “home remedy” such as honey and lemon.
• Honey (1-2 teaspoons) can be used to soothe throat irritation and suppress coughing, particularly effective when taken before bedtime, as it has been reported to have a positive effect on patients 1.
• Over-the-counter options like dextromethorphan (15-30mg every 6-8 hours) for dry, non-productive coughs, can be considered, but it's essential to weigh the benefits against the potential side effects, as opiate antitussives have a significant adverse side effect profile and are not recommended 1.
• Avoiding irritants like cigarette smoke, strong perfumes, and pollutants that can worsen cough symptoms is also crucial.
• If the cough persists beyond 2-3 weeks, is accompanied by fever over 100.4°F, produces discolored mucus, or causes breathing difficulties, medical evaluation is necessary, as these may indicate a more serious underlying condition requiring prescription treatment. The study published in Chest in 2006 1 also provides guidance on the diagnosis and management of cough, but the recommendations from the Thorax study 1 are more relevant to conservative management. It's also important to note that central modulation of the cough reflex is common, and simple voluntary suppression of cough may be sufficient to reduce cough frequency, as suggested by the study 1. In terms of specific medications, the study 1 mentions that active agents include dextromethorphan, menthol, sedative antihistamines, and codeine or pholcodine, but it's essential to use these medications judiciously and consider the potential side effects. Overall, a conservative approach to managing a cough should focus on soothing throat irritation, suppressing coughing, and avoiding irritants, while also being mindful of the potential side effects of over-the-counter medications, as recommended by the study published in Thorax in 2006 1.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. temporarily relieves: cough due to minor throat and bronchial irritation as may occur with a cold or inhaled irritants your cough to help you sleep helps loosen phlegm (mucus) and thin bronchial secretions to rid the bronchial passageways of bothersome mucus and makes cough more productive Purpose Cough suppressant

For conservative management of a cough, options include:

• Using guaifenesin (PO) 2 to help loosen phlegm and make coughs more productive
• Using codeine (PO) 3 to temporarily relieve cough due to minor throat and bronchial irritation
• Using dextromethorphan (PO) 4 as a cough suppressant Key considerations for conservative management include using the lowest effective dose and monitoring for potential side effects.

From the Research

Conservative Management of Cough

The conservative management of cough involves a variety of approaches, including the use of anti-tussive agents and symptomatic treatments.

• The potential benefits of early treatment of cough include the prevention of the vicious cycle of cough 5.
• According to the current guidelines, it should be possible to diagnose and treat cough successfully in a majority of cases 5.
• Peripherally acting anti-tussives such as levodropropizine and moguisteine show the highest level of benefit and should be recommended especially in children 5.

Anti-Tussive Agents

Anti-tussive agents are commonly used in the management of cough.

• Dextromethorphan (DXM) is a safe and effective antitussive agent present in several over the counter cough and cold medications 6.
• However, at higher doses, DXM can cause psychoactive effects, making it appealing for abuse 6.
• The pharmacokinetics and pharmacodynamics of DXM can result in large inter-individual variability in the pharmacological and toxicological effects produced 6.

Acute Cough Management

Acute cough is a frequent complaint in family practice consultations.

• The most common cause of acute cough is respiratory infections 7.
• The Guideline "Acute and chronic cough" of the German College of General Practitioners and Family Physicians (DEGAM) recommends an evidence-based approach for the management of acute cough in primary care 7.
• There is inadequate evidence for the efficacy of antitussive or expectorant drugs against acute cough 7.
• COVID-19 should currently be considered in cases of acute respiratory symptoms 7.

Challenges in Cough Management

Cough management can be challenging due to the limited availability of effective treatments.

• Many patients use over-the-counter medicines, which are often ineffective for symptom relief 8.
• Some therapies may achieve antitussive activity, but at the expense of unpleasant or intolerable side effects 8.
• There is a need for the generation of quality scientific data from well-performed clinical trials to develop safer, more effective, and more reliable therapeutic options in the management of acute cough 8.