Cough Medicines: How do you know which is the right one?

Mar 10, 2019 Dr Zulfikar Bux, Features / Columnists

Assistant Professor of Emergency Medicine

We have all had the unpleasant experience of having a cough. Sometimes it becomes annoying and we need help to suppress or get rid of it. Cough medicines are usually our number one choice. However, we are not always sure which is the best option for our cough.
Today, I will share some information on cough medicines so that you can be better informed when you are choosing a cough medicine.

WHAT IS A COUGH?

A cough is an automatic response to irritation of the airways in the lungs. Having a cough is the main symptom of an upper respiratory tract infection (URTI). However, a cough can also be a symptom of other conditions such as asthma or other lung diseases.
When you have a cough caused by a URTI, it may be described as being either a chesty cough or a dry cough. If you have a chesty cough this usually means that your lungs are producing more phlegm or mucus (cold) than normal, because you have an infection, and you are coughing up extra mucus and debris from the infection. If you have a dry cough this usually means that you are coughing a lot, but nothing comes out when you cough.

WHAT ARE COUGH MEDICINES?
Cough medicines aim either to suppress a dry cough, or to help you to cough up the extra phlegm (mucus) of a chesty cough when you have a URTI. There is little good evidence that they do help. This is partly because many coughs get better quickly on their own anyway, so it is hard to tell if the medicine has helped or if the cold has simply got better. A glycerin, honey and lemon cough medicine is also available to buy. This preparation does not have an active ingredient as such. It is thought to have a soothing action. Cough medicines can also contain other medicines such as paracetamol or ibuprofen. Some contain alcohol.

HOW DO COUGH MEDICINES WORK?
If cough medicines do work, they are thought to work in different ways, depending on what the active ingredient is:
• Antitussives are said to work by reducing the cough reflex. For example, dextromethorphan or pholcodine.
• Expectorants try to help loosen secretions, so you cough up the excessive mucus (cold) – for example, guaifenesin or ipecacuanha.
• Antihistamines reduce histamine release. This reduces congestion and decreases the amount of secretions (cold) made by the lungs. Examples are brompheniramine, chlorphenamine, diphenhydramine, doxylamine and promethazine.
• Decongestants cause the blood vessels in the lungs and nose to narrow (constrict), and this reduces congestion. Examples are phenylephrine, pseudoephedrine, ephedrine, oxymetazoline or xylometazoline.

WHICH COUGH MEDICINE SHOULD YOU BUY?

If you have a dry cough, a preparation containing an antitussive such as dextromethorphan or pholcodine is the most suitable to try. If you have a chesty cough, a preparation containing an expectorant such as guaifenesin or ipecacuanha is the most suitable to try. Your pharmacist can advise you which one may be suitable for you.

WHAT COUGH MEDICINE CAN CHILDREN USE?
For children under 6 years of age, its best to give them simple preparations such as glycerin, honey, and lemon. Do not give children who are younger than 6 years old cough medicines with any of the active ingredients listed above (antitussives, expectorants, antihistamines, or decongestants). This is because the risk of a young child having a side-effect to one these preparations is greater than any possible benefit of the medicine. Children older than 6 years old can usually take cough medicines safely.

WHAT ARE POSSIBLE SIDE EFFECTS?
Most people who take cough medicines do not have side-effects. Some cough preparations (for example, pholcodine and diphenhydramine) can cause drowsiness. If you are drowsy after taking a cough medicine, you should not drive and you should not operate machinery. The leaflet that comes with your medicine will state if the medicine can cause drowsiness. Pholcodine may cause constipation.
As with all medicines, cough medicines should only be taken for the shortest period of time necessary, and most people only need to use a cough medicine for a few days. In general, most coughs do not last more than 2-3 weeks. If your cough does last longer than this, or there are other symptoms such as shortness of breath and/or high fever, then you should go to see your doctor.

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