Cough

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Updated 22 August 2017

Cough treatment has come a long way

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Millions of people around the world swallow spoonfuls of cough syrup every day in the misplaced belief that it will make them better. However, thanks to advances in medicine, there’s a now a clinically sound wet cough solution.

Cold and flu season usually brings on hacking wet coughs, caused by too much mucus.1pg1a Coughs make the throat feel scratchy and sore, leave the chest muscles aching, disrupt sleep and make it difficult for people to function efficiently.2pg1a

As one of the most common symptoms for which people seek medical care, the global healthcare industry has spent many years looking for wet cough remedies that really work. Respiratory drugs – including cough medicines – make up more than one-third of the over-the-counter market.3pg1d

At the turn of the century in the US, among the many weird cough preparations was the One Minute Cough Cure. It claimed to work for "all diseases of the throat, bronchial tubes and lungs" using wild cherry as the key ingredient. 4pg1a+pg2b

Home remedies like honey and lemon are still used today to alleviate an irritating cough and soothe a sore throat.5pg1a

Cough treatment has come a long way

There are a number of non-prescription, over-the-counter (OTC) cough and cold medications for wet coughs. These products include combinations of one or more of the following:

Expectorants: These are among the common OTC cough and cold medications. One example is guaifenesin.6pg175a

Demulcents: These are products that contain ingredients like honey and lemon. They can be soothing, but there is no evidence for their efficacy.7pg26b

Mucolytics: Mucolytics work by breaking down the bonds that hold mucus together, making it less sticky and thick, and therefore easier to cough up. A good example is N-acetylcysteine (NAC).8pg216a

In addition, analgesics and antipyretics such as acetaminophen and ibuprofen are often combined with cold medications. The risk of overdose, incorrect dosing, and adverse drug reaction is increased in young children due to the number of colds they acquire each year, their small body size, and parents’ lack of clarity about the active ingredients in these OTC medications, particularly those with multiple ingredients. 6pg216a+b+c

It’s advisable, therefore, to always check the ingredients.

More controversially, according to a 2015 report by eNCA’s investigative current affairs, Check Point found that cough syrups containing codeine was the most abused OTC drug in South Africa. Codeine, in whatever form, is habit-forming and may be detrimental to your health if abused or not used according to the doctor’s prescription or pharmacist’s recommendation.9pg1a

Proceed with caution

Savvy consumers are becoming increasingly aware of the contents and limitations of cough syrups and, thanks to a vast amount of information available online, are questioning the effectiveness of what they put into their bodies.10pg1a+b+c+d Further, despite the advances made, there is still no good evidence for or against the effectiveness of OTC cough syrups – including suppressants and expectorants – to reduce coughing. Research suggests that honey appeared to be as effective as some cough suppressants in typical over-the-counter doses. 5pg1b, 11pg3a

As a result of inadequate evidence supporting the effectiveness of cough syrups, large trials in both adults and children are needed to provide more evidence of their value.7pg27c Moreover, due to their small bodies and frequency of infections, young children are at higher risk of overdose, incorrect dosing and side effects, especially if a cough syrup contains multiple ingredients. 6pg175b

Choose the right option

One potential root of the problem with many cough syrup treatments is the fact that that wet coughs are most often caused by thick, sticky phlegm irritating the chest. There is no solid evidence for or against the effectiveness of cough syrups in patients with wet cough.11pg3a

The good news is that excessive phlegm in the chest can be effectively treated using solid form mucolytics such as N-acetylcysteine (NAC), the active ingredient in OTC products such as ACC 200, Mucofizz and Solmucol. A recent study found that NAC may reduce wet cough and is safe for children over the age of two. 12pg16c

The research suggests that mucolytics may be effective because they target and thin phlegm, making it less viscous, so the body can absorb it or expel it more efficiently.8pg216a

Those available in effervescent tablet form are easy to administer, making NAC a quick and effective treatment method. It works by breaking the links that bind phlegm together, loosening phlegm build-up in the chest, making it less sticky and easier to cough up.8pg216a This improves drainage and helps to reduce wet cough.

When we’re sick with a wet cough – or worse, when our children are sick – we’ll do anything to find relief. It’s reassuring to know that proven, solid form mucolytics are suitable for the whole family. Because they can quickly and effectively break down thick phlegm, they may help to clear wet coughs because they improve flow, thus improving cough clearance. 8pg216a

Ask your healthcare provider to assist you in selecting a suitable product.

References:
1. MedicineNet. [Internet]. Chronic Rhinitis and Post-Nasal Drip. [updated 2016 Sept 14; cited 2017 Apr 28]. Available from: http://www.medicinenet.com/chronic_rhinitis/article.htm
2. WebMD. [Internet]. Cough Relief: How to Lose a Bad Cough. [cited 2017 Apr 28]. Available from: http://www.webmd.com/cold-and-flu/features/cough-relief-how-lose-bad-cough#1
3. Business Wire [Internet]. Rise in Self-medication to Create Opportunities for the Global Over-the-Counter Drug Market Through 2020, Reports Technavio. New York: Berkshire Hathaway; [updated 2016 August 25; cited 2017 March 10]. Available from: http://www.businesswire.com/news/home/20160825005019/en/Rise-Self-medication-Create-Opportunities-Global-Over-the-Counter-Drug
4. The National Museum of American History [Internet]. One Minute Cough Cure. [cited 2017 Apr 05]. Available from: http://americanhistory.si.edu/collections/search/object/nmah_714548
5. Mayo Clinic. [Internet]. Honey: An effective cough remedy? [2015 Jun 05; cited 2017 Apr 28]. Available from: http://www.mayoclinic.org/diseases-conditions/common-cold/expert-answers/honey/faq-20058031?p=1
6. Ryan T, Brewer M, Small L. Over-the-counter cough and cold medication use in young children. Ped Nurs 2008;34(2):174-184.
7. Truter I. Cough. Evidence based pharmacy care. S Afr Pharm J 2007;20-27.
8. Rubin BK. The pharmacologic approach to airway clearance: mucoactive agents. Paed Resp Rev 2006;7S:S215-S219.
9. Health24 [Internet]. Why SA continues selling 'most abused over-the-counter drug'. [updated 2017 Jan 13; cited 2017 Apr 04]. Available from: http://www.health24.com/Medical/Cough/Cough-medication/why-sa-continues-selling-most-abused-over-the-counter-drug-20160318
10. NBC News. [Internet]. More people search for health online. [updated 2013 Jul 16; cited 2017 Apr 28]. Available from: http://www.nbcnews.com/id/3077086/t/more-people-search-health-online/#.WQhSRdKGM2w
11. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD001831. DOI: 10.1002/14651858.CD001831.pub5.
12. Hanson C. Cough syrups – an overview. S Afr Pharm J 2016; 83(5):14-17

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Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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