Acute cough (Cough)

Acute Cough – Treatment Options

Introduction
Acute cough is defined as a cough lasting less than three weeks. It is most commonly caused by viral upper respiratory tract infections, but may also result from acute bronchitis, allergic rhinitis, asthma exacerbations, pneumonia, postnasal drip, or environmental irritants. While usually self-limiting, management focuses on symptom relief, identifying red flags, and treating underlying causes when present.

1. General and Supportive Measures

• Hydration: Adequate fluid intake helps thin mucus and ease clearance.

• Humidified air/steam inhalation: Provides symptomatic relief of airway irritation.

• Rest: Supports immune recovery in viral infections.

• Avoidance of irritants: Smoking cessation, reduced exposure to dust, pollutants, and strong odors.

2. Pharmacologic Therapies (Symptomatic Relief)

• Antitussives (cough suppressants):

  • Dextromethorphan: Commonly used OTC agent for dry, non-productive cough.

  • Codeine or hydrocodone: Effective but limited by risk of dependence and side effects; reserved for severe cough.

• Expectorants (mucolytics):

  • Guaifenesin: Helps loosen secretions in productive cough.

• Antihistamines (first-generation: diphenhydramine, chlorpheniramine): Reduce postnasal drip–related cough; sedating effect may be helpful at night.

• Intranasal corticosteroids: For allergic rhinitis–related cough.

• Bronchodilators (albuterol/salbutamol): Indicated if cough is associated with asthma or bronchospasm.

3. Treatment of Underlying Causes

• Viral upper respiratory infection: Supportive care; antibiotics not indicated.

• Acute bacterial sinusitis or pneumonia: Appropriate antibiotic therapy guided by clinical features and imaging.

• Asthma exacerbation: Inhaled bronchodilators and corticosteroids.

• GERD-related cough: Proton pump inhibitors or H₂ blockers in confirmed cases.

4. Red Flag Indicators (Require Urgent Evaluation)

• Hemoptysis.

• Shortness of breath or hypoxemia.

• Chest pain suggestive of cardiac or pulmonary disease.

• Persistent fever > 38.5 °C.

• Immunocompromised patients.

5. Lifestyle and Preventive Measures

• Vaccinations: Influenza and pneumococcal vaccines reduce cough-related infectious illnesses.

• Hand hygiene: Prevents spread of viral respiratory infections.

• Avoid overuse of antibiotics: To prevent resistance in viral causes.

6. Multidisciplinary Care

• Primary care physicians: For initial evaluation and management.

• Pulmonologists: For recurrent, severe, or unexplained cough.

• Allergists: For allergic rhinitis or asthma-related cough.