Safe Treatments for Cough

Author: L. Kendall Shaw, PharmD

Cough is among the most common maladies for which pharmacists are consulted for treatment. Many people tend to trivialize cough as just another annoying symptom of an upper respiratory infection, but a nagging cough can slow recovery, and a severe cough can even be dangerous for some people. When choosing cough medicine, most people rely on what they?ve seen advertised or what may have seemed to work previously, but treating a cough properly is complex and requires careful application of both clinical and pharmacologic insight that may be unique to the pharmacist. Cough is usually accompanied by underlying problems that can range from benign and self-resolving to chronic or even life-threatening, depending on patient variables and comorbid illness. Effective treatment involves addressing or resolving the underlying cause while recognizing the significance of the cough itself on one?s overall health.

Take Cough Seriously
Far from a trivial annoyance, cough has developed over time as a protective mechanism to expel material that doesn?t belong in the respiratory tract. Cough can become a serious health problem, however, causing severe complications, especially in someone who is already ill or debilitated. Severe or uncontrolled cough can:

Treatment of cough should be aimed at mobilizing and expectorating bronchial secretions and minimizing abnormal stimulus of cough receptors by removal of irritation. The old tenet that only the nonproductive cough should be suppressed cannot be universally applied, because reducing the frequency of even a productive cough can facilitate rest and recovery in many cases.

Accepted methods for treating cough include:

The Potential for Side Effects
Many pharmacologic remedies for cough are capable of causing significant side effects, even in nonprescrip-tion doses. In patients with various illnesses and those taking other medications, either prescription or nonpre-scription, these products can be outright dangerous. According to the FDA, nonprescription doses are generally safe for most potential users, and manufacturers are diligent about adequate caution labeling; but patients must read warnings and follow directions.

What to Avoid
First-generation antihistamines should not be taken by patients with narrow-angle glaucoma, peptic ulcer, prostatic hypertrophy, bladder neck obstruction, or pyloroduodenal obstruction. Elderly and debilitated patients and those taking monoamine oxidase inhibitors should also avoid these agents.

Special Populations

What to Remember
There is no short answer to the complex question of how to treat a cough, and each person has unique needs.