A chronic cough is defined as a cough that persists for eight weeks or longer in adults or four weeks or longer in children. This persistent condition can be more than just an annoyance, often disrupting sleep, causing fatigue, and in severe cases, leading to complications such as vomiting, lightheadedness, or even fractured ribs. Managing a chronic cough frequently involves identifying and addressing its underlying causes, and medication plays a significant role in this process. This article will explore various types of medications used to manage chronic cough, from over-the-counter options to prescription treatments.
Common Causes of Chronic Cough
A chronic cough is a symptom of an underlying health issue, and effective treatment targets these specific causes. One common culprit is postnasal drip, where excess mucus from the nose or sinuses drains down the back of the throat, triggering the cough reflex. Allergies or sinus infections can lead to this increased mucus production.
Asthma is another frequent cause, where airways become inflamed and narrow, leading to coughing, wheezing, and shortness of breath. In some cases, cough may be the only symptom of asthma, a condition known as cough-variant asthma. Gastroesophageal reflux disease (GERD), often called acid reflux, can also induce a chronic cough when stomach acid irritates the esophagus and throat. Certain medications, particularly angiotensin-converting enzyme (ACE) inhibitors used for blood pressure and heart conditions, are known to cause a dry, persistent cough as a side effect.
Over-the-Counter Options
When dealing with a chronic cough, several over-the-counter (OTC) medications can provide temporary relief by addressing different aspects of the cough reflex or mucus production. Cough suppressants, such as dextromethorphan, work by acting on the brain’s cough center to reduce the urge to cough. Dextromethorphan is taken every 4 to 12 hours as needed, and it is important to follow package directions carefully, not exceeding the recommended dose within a 24-hour period.
Expectorants, such as guaifenesin, function differently by thinning and loosening mucus in the airways, making it easier to expel. Guaifenesin is available in tablets, capsules, or syrups, taken every 4 hours as needed, or every 12 hours for extended-release formulations.
For coughs linked to postnasal drip, antihistamines and decongestants can be helpful. Antihistamines work by blocking histamine receptors, which helps reduce mucus production, particularly in allergy-induced postnasal drip. Decongestants, such as pseudoephedrine, decrease swelling in nasal passages, easing symptoms like a runny nose and congestion. Decongestants should not be used for more than 3 to 5 days to avoid rebound congestion.
Prescription Treatments
When over-the-counter options are insufficient or a specific underlying cause is identified, healthcare providers may prescribe stronger medications. For asthma-related cough, inhaled corticosteroids are used to reduce inflammation and swelling in the airways, preventing mucus overproduction. Bronchodilators, such as short-acting beta-2 agonists (SABAs) like albuterol, rapidly relax the muscle bands around the airways, allowing more air to flow in and out of the lungs and helping to clear mucus. Long-acting bronchodilators (LABAs) are often used daily for long-term control, sometimes in combination with inhaled corticosteroids.
For cough caused by gastroesophageal reflux disease (GERD), proton pump inhibitors (PPIs) are prescribed. These medications reduce stomach acid secretion. Examples include omeprazole and esomeprazole. Histamine H2 receptor antagonists (H2 blockers), such as famotidine, also reduce stomach acid and may be added to PPI therapy.
Severe postnasal drip may warrant prescription-strength nasal corticosteroids like fluticasone or mometasone, which reduce inflammation and mucus production in the nasal passages. Prescription antihistamines, sometimes in combination with nasal corticosteroids, can further alleviate nasal inflammation. For chronic cough that doesn’t respond to treatments and is suspected to have a neuropathic origin, medications like gabapentin or pregabalin may be considered. These medications work by calming nerve endings in the throat.
Opioid-based cough suppressants, such as codeine and hydrocodone, work directly on the cough center in the brain to relieve coughing. However, their use is limited due to concerns about potential side effects, including respiratory depression, and the risk of misuse, abuse, and addiction. These medications are reserved for specific situations and are not considered long-term solutions for chronic cough.
Important Considerations for Medication Use
When using medications for chronic cough, it is important to be aware of potential side effects, which can vary depending on the specific drug. Common side effects across various cough medications may include drowsiness, dizziness, nausea, vomiting, stomach upset, or dry mouth. Some medications can also lead to more serious effects such as confusion, hallucinations, or an irregular heartbeat.
Considering potential drug interactions is also important, as some cough medications can interact with other prescriptions or even other over-the-counter products. For example, dextromethorphan can interact with certain antidepressants, increasing the risk of serotonin syndrome. It is always advisable to consult a healthcare professional or pharmacist to review all medications being taken to prevent adverse interactions.
Identifying the underlying cause of a chronic cough is important before embarking on long-term medication use, as treating the symptom without addressing the root cause may not provide lasting relief. If a cough worsens, new symptoms appear, there is no improvement after a reasonable time with over-the-counter medications, or severe side effects occur, seeking medical attention is important. Adhering to prescribed dosages and duration is also necessary to ensure both effectiveness and safety.