The common cold is an overwhelmingly prevalent acute illness in most communities. It presents with a variety of symptoms, one of which is a nagging cough with which most people are all too familiar. Before recommending any OTC cough suppressants, pharmacists must remind patients to consult a medical professional before giving these medications to children younger than 4 years.1

PHARMACISTS’ TOP CHOICES
What is the best way to stop coughing? That is a million-dollar question. In 2019, 44% of pharmacists surveyed in Pharmacy Times®’ 2019 OTC Guide® recommended Delsym (dextromethorphan) as a first-line cough suppressant. Another 30% suggested Mucinex DM (guaifenesin/dextromethorphan), and 20% advocated for Robitussin (guaifenesin). It is true: Antitussives and expectorants are the mainstays of OTC therapy to stop coughing. Antitussives are indicated in dry and persistent coughs, while expectorants, such as guaifenesin, should be recommended when patients complain of wet coughs, which are often accompanied by mucus.1

It is also important to address patients’ expectations. The American Academy of Family Physicians found that dextromethorphan decreased cough count by 19% to 36%, which translated to 8 to 10 fewer coughs over 30 minutes. Guaifenesin had seemingly more favorable results, decreasing cough frequency and intensity by 75% after 3 days, but the results were not statistically significant (P = .5).2 Additionally, clinicians should tell patients to discontinue use if they develop serious adverse effects, including confusion; swelling of the face, lips, or tongue; or shortness of breath.3 Overall, OTC products cannot cure that troublesome cough but, when used appropriately, can help with symptom management and even provide peace of mind.

COMPLEMENTARY AND ALTERNATIVE MEDICINE
Many people look to home remedies or natural products to relieve persistent coughs. One of the best-researched options is honey. Giving a child with a cough 1.5 to 2 Tbsp of honey 30 minutes before bedtime has been recommended as a way to increase sleep for both the child and the caregiver. Using honey may or may not be effective in adults.4 It is important to note that the FDA does not monitor other common complementary and alternative medicines, and they should be used with caution. These include ginger, marshmallow root, probiotics, and thyme.5 The FDA does recommend gargles, nasal sprays, and saline drops to keep mucous membranes moist and loosen mucus.6 Finally, running humidifiers or cool-mist vaporizers at the bedside can moisten the air and help ease airway irritation that might be causing the cough. Patients should see a medical professional if symptoms do not resolve in 2 weeks or get worse. 


For more pharmacist OTC recommendations, visit The OTC Guide website
 
Emily C. Hayes is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.

REFERENCES
  1. Cough and cold medicine over-the-counter. Nationwide Children’s Hospital website. nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/cough-and-cold-medicine-over-the-counter-otc. Accessed May 3, 2019.
  2. Kinkade S, Long NA. Acute bronchitis. Am Fam Physician. 2016;94(7):560-565.
  3. Dextromethorphan. New Zealand Consumer Medicine Information website. medsafe.govt.nz/consumers/CMI/CoughandCold/Dextromethorphan1.pdf. Published November 4, 2010. Accessed May 5, 2019.
  4. Ashkin E, Mounsey A. PURLs: a spoonful of honey helps a coughing child sleep.  J Fam Pract. 2013;62(3):145-147.
  5. Leonard J. What can I do to make my cough go away? Medical News Today. July 9, 2018. medicalnewstoday.com/articles/322394.php. Accessed May 5, 2019.
  6. FDA. When to give kids medicine for coughs and colds. FDA website. www.fda. gov/ForConsumers/ConsumerUpdates/ucm422465.htm. Updated November 27, 2018. Accessed March 5, 2019.