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TREATING A COUGH

A cough can be debilitating and distressing, especially in children. But although coughing can affect sleep, quality of life and productivity,1 it has an important function: it clears the airways of mucus and prevents foreign bodies and irritants from being inhaled into the lungs.2

An acute cough caused by viral respiratory tract infections is probably the most common illness in humans3 and, in many cases, its cause may not require investigation.4 It is usually treated symptomatically, using over-the-counter (OTC) medications.3  

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Why do we treat a cough?

The primary goal for the treatment of a productive cough (wet cough) is to support expectoration (getting phlegm out of the airways by coughing or spitting). This ultimately reduces coughing by making it easier for the cough to do what it is supposed to do (i.e. remove phlegm).5 The treatment of cough also alleviates symptoms such as poor sleep, feeling unwell, breathlessness and chest pain.5

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Will antibiotics help with a cough?

In most cases, antibiotics are not necessary to treat cough.6 This is because acute cough is usually caused by a viral infection4 and antibiotics are only effective against bacterial infections.7 Antibiotics need to be prescribed by a doctor.8 Taking an antibiotic when you don’t have a bacterial infection may result in the antibiotic not working as effectively when you do need them.9

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Common medications used to treat cough

PLEASE NOTE: Some OTC medications are not approved or recommended for children.If you are treating your child, please consult with your doctor or pharmacist before administering OTC medication.

Mucolytics

According to a survey carried out in one country, pediatricians tend to prescribe mucolytics 85% of the time to treat acute cough.2 A well-known mucolytic is N-Acetylcysteine (NAC).3,10 ACC 200, a registered mucolytic in South Africa and available over the counter, contains NAC as its active ingredient.12

Clinical trials have shown that mucolytics play an important role in relieving cough symptoms, including their frequency and intensity.1,5 NAC is quick and effective in thinning, and breaking down thick phlegm without increasing its volume.13,14,15 The effects can be observed within the first days of treatment13 and it has a good safety profile.16 The broken-down phlegm is easier to cough up,14 which means that bacteria may be less likely to infect it and cause chest infections.16

NAC has been shown to be safe and effective in children from the age of two.14,12 ACC 200 can be given to children from two years of age without a prescription.12  

When using OTC medications, remember that dosage instructions should always be carefully followed.

Cough suppressants

Cough suppressants, also referred to as antitussives,1,7 are usually in a liquid form and are what most people know as a ‘cough syrup’. Cough suppressants may be recommended for a dry, irritating and non-productive cough7 or if you are coughing so much that your chest hurts, or if your sleep is disturbed.17,18 This is because they may help to control night-time cough.18

Always keep in mind, however, that the cough reflex has an important protective function.2,7 Without an effective cough reflex, there may be a risk of phlegm building up and getting stuck in the airways and this may predispose you to infection and possibly compromise your respiratory function.4

There are two types of cough suppressants: those which have an effect on the central nervous system (work on the cough centre in the brain) and those which exert an effect on the peripheral nervous system (work on the respiratory tract).1,15

Cough suppressants which have an effect on the central nervous system, such as morphine and codeine, may inhibit cough but may also have side effects including raised intracranial pressure, breathing difficulties, mood changes, convulsions, dependency, addiction and coma.1,19,20,21,22

Cough expectorants

Expectorants are usually available in liquid form and are also commonly known as a ‘cough mixture’ or ‘cough syrup’. Expectorants may assist you to cough up thick phlegm.17 They work by increasing the amount of fluid that the bronchi (airways near the lungs) produce.7,23

Combination treatments

Some cough treatments combine a cough suppressant with an expectorant, which doesn’t always make sense: one is trying to increase coughing up of phlegm and the other is trying to stop the cough reflex, so they act against one another.4,7

As combination medicines contain more than one active ingredient, they may well have side effects.7 It is therefore important to understand which active ingredients are in any cough medication you may use to treat yourself or your child.

 

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References
  1. De Blasio F et al. Cough management: a practical approach. Cough 2011; 7:7.
  2. Dal Negro RW et al. Acute cough in Italian children: parents’ beliefs, approach to treatment, and family impact. Multidiscip Respir Med 2019; 14:16.
  3. Morice A and Kardos P. Comprehensive evidence-based review on European antitussives. BMJ Open Resp Res 2016; 3:e000137.
  4. Mutie M. Acute and chronic cough presentations in pharmacy. Pharmacy Education 2014 Jun; 65-67.
  5. Scaglione F and Petrini O. Mucoactive agents in the therapy of upper respiratory airways infections: fair to describe them just as mucoactive?    Clin Med Insights Ear Nose Throat 2019; 12:1-9.
  6. https://www.nice.org.uk/news/article/antibiotics-should-not-be-issued-as-first-line-of-treatment-for-a-cough-says-nice-and-phe
  7. Schellack N and Labuschagne Q. Overview and management of colds and flu. S Afr Pharm J 2014; 81(6):19-26.
  8. Mayo Clinic. Chronic cough. Last updated: 22 Aug 2017. Available at: https://www.mayoclinic.org/diseases-conditions/chronic-cough/diagnosis-treatment/drc-20351580. Last accessed May 2019.
  9. BMJ Best Practice. Common cold. Last updated: 19 Oct 2018. Available at: https://bestpractice.bmj.com/. Last accessed May 2019.
  10. Rubin BK. Mucolytics, expectorants, and mucokinetic medications. Respir Care 2007; 52(7):859-865.
  11. Health24. Acetylcysteine. Last updated: 16 Jan 2017. Available at: https://www.health24.com/Medical/Cough/Cough-medication/Acetylcysteine-Client-20120721. Last accessed Jul 2019.
  12. Sandoz SA (Pty) Ltd. ACC 200 approved package insert. May 2018.
  13. Kakhnovsky IM et al. Evaluation of potency of acetylcysteine effects on rheological properties of phlegm. Clin Pharm Ther 1997; 1.
  14. Medical Academic. The role of mucus in your body. Available at: https://www.medicalacademic.co.za/news/mucus-and-phlegm-when-ill/.Last accessed May 2019.
  15. https://www.gov.uk/drug-safety-update/over-the-counter-cough-and-cold-medicines-for-children
  16. Knott L. Mucolytics. Last updated: 27 Nov 2018. Available at: https://patient.info/chest-lungs/chronic-obstructive-pulmonary-disease-leaflet/mucolytics. Last accessed Jun 2019.    
  17. WebMD. Cough relief: how to lose a bad cough. Last updated: 01 Jul 2015. Web MD Archives. Last accessed May 2019.
  18. Pek W et al. Cough in lower airway infections.9:83-92
  19. Morice AH et al. Recommendations for the management of cough in adults. Thorax 2006; 61 Suppl 1:i1-24. Available at: https://thorax.bmj.com/content/61/suppl_1/i1. Last accessed May 2019.
  20. Data on file.
  21. Data on file.
  22. Data on file.
  23. Rubin BK. Mucolytics, expectorants, and mucokinetic medications. Respir Care 2007; 52(7):859-865.