Cough Symptomatic Treatment

Aka: Cough Symptomatic Treatment, Cough Drops, Cough Preparation, Intractable Cough, Cough Management

1. See Also
   1. Chronic Cough
   2. Cough Suppressant
   3. Cough Expectorant
2. Management: General measures to relieve cough
   1. See Cough Suppressant
   2. Cough Drops
      1. Children over age 4 years only (risk of Choking)
      2. Eucalyptus oil may be best
   3. Honey (1-2 teaspoons)
      1. Suppresses cough and improves sleep in children with Upper Respiratory Infection
         1. Cohen (2012) Pediatrics 130(3): 465-71 [PubMed]
      2. Avoid honey in younger than 1 year (Botulism Risk)
      3. Homemade cough syrup: Teaspoon honey and 2 drops lemon juice
         1. Some recipes substitute corn syrup
   4. Warm brews (warm liquids are usually soothing)
   5. Humidifiers may loosen Sputum produced with cough
   6. Mentholated ointment (e.g. Vicks)
      1. Avoid camphor products under age 2 years (risk of absorption and hepatotoxicity)
      2. No proven benefit, but may be soothing
3. Management: Avoid activities provoking cough
   1. Exercise may trigger coughing spasms
   2. Tobacco Smoke (active or passive) should be avoided!!
      1. Continued smoking will prolong cough for weeks
4. Management: Treat suspected underlying cause of cough
   1. Allergic Rhinitis
      1. Antihistamine
      2. Nasal Corticosteroid (e.g. Flonase)
      3. Singulair
   2. Post-Bronchitic cough (>3 weeks)
      1. Ipratropium BromideInhaler
      2. Inhaled Corticosteroid
      3. Prednisone for 5 day course (severe cough)
   3. Acute Bronchitis with bronchospasm
      1. Albuterol MDI
      2. Advair (not typically covered or recommended)
   4. Asthma Exacerbation
      1. Albuterol MDI
      2. Inhaled Corticosteroid
      3. Prednisone for 5 day course (severe exacerbation)
   5. Upper Respiratory Infection with postnasal Drainage
      1. Nasal Saline
      2. Guaifenesin (e.g. Mucinex)
      3. NSAIDs (may reduce upper airway inflammation)
      4. Combination Antihistamine-Decongestant
         1. Antihistamine may reduce nighttime postnasal drainage but may predispose to Sinusitis
   6. Gastroesophageal Reflux Disease
      1. Antacid Medication (e.g. Proton Pump Inhibitor)
   7. Paroxysmal cough without RAD exacerbation
      1. Consider Pertussis (Whooping Cough)
      2. Nebulized Lidocaine
5. Efficacy
   1. Nonprescription Cough Preparations
      1. No clear benefit of any agent compared with Placebo
      2. Many agents are associated with adverse effects
      3. Schroeder (2002) BMJ 324:329-31 [PubMed]
   2. Corticosteroids
      1. Prednisone 40 x5 days had no benefit in reducing severity or duration of non-Asthmatic cough
         1. Hay (2017) JAMA 318(8):721-30 +PMID:28829884 [PubMed]