Treatment of acute cough in adults
Reassure patients that acute cough usually resolves without treatment.
Many over-the-counter medications are available for acute cough. Although commonly used, they are not generally recommended because they have minimal, if any, benefit in acute cough and can cause adverse effectsMalesker, 2017.
Evidence for over-the-counter medications in acute cough, as summarised in a systematic review1, is outlined belowSmith, 2014:
- mucolytics—bromhexine may reduce cough frequency
- expectorants—guafenesin has conflicting evidence of benefit in cough
- antihistamines—no more effective than placebo for cough
- antihistamine+decongestant combinations—have conflicting evidence of benefit in cough
- cough suppressants—dextromethorphan has conflicting evidence of benefit in cough; codeine is not more effective than placebo.
Evidence for the benefit of honey in cough mainly comes from studies of childrenNICE, 2019. There is some evidence of benefit in adults with cough, although more studies are needed. Honey may be trialled in adults with cough because it is safe and easily accessible.
The expectorant senega with ammonia has no evidence of benefit in cough.
Evidence for benefit of complementary therapies (eg pelargonium, ivy leaf extract [Hedera helix], echinacea) in cough is uncertainNICE, 2019Timmer, 2013Wagner, 2015. Severe allergic reactions have been reported with echinacea and pelargonium. There is no evidence for the use of ‘salt therapy’ (salt caves, salt rooms or inhalation of salt) in treatment of cough in adults.
For cough associated with a self-limiting respiratory tract infection (eg acute bronchitis, acute rhinosinusitis), many patients have an expectation of treatment with antibiotics. Effective communication with the patient or carer about the role of antibiotics is essential. The discussion should address misconceptions about the effectiveness of antibiotic therapy and the expectation of an antibiotic prescription. Resources to help discussion of the evidence for the potential benefits and harms of antibiotic therapy are available for:
Providing a ‘prescription’ with advice about nonspecific strategies for dealing with acute respiratory tract infection may also be useful to reduce patient expectation for antibiotics. The NPS MedicineWise website provides handouts with advice about nondrug management.