Cough can be a bothersome symptom for many people and often may lead to doctor visits for treatment. If a cough lasts less than eight weeks, it is considered ‘acute’ or ‘subacute’. Coughs lasting more than eight weeks are considered ‘chronic’ according to the American College of Chest Physicians. If a cough lasts more than three weeks, it is important for your doctor to determine if there is an underlying cause of the cough. If there is an underlying cause of the cough, it is unlikely to go away until the cause itself is treated or fixed. Cough could be caused by diseases, medications, inhaling dust or particles, or lifestyle choices (I.e., smoking), to name a few examples.
Productive Cough vs Non-Productive Cough
A cough may be considered either productive or nonproductive. If you are producing phlegm or sputum when coughing, it is considered productive. It is important for the body to get rid of the secretions it is trying to cough out, as the phlegm can impair your lungs’ ability to function if not coughed up. Coughs that don’t produce phlegm and are more of a dry, “hacking” nature are considered nonproductive (or dry) coughs. For short-lived dry, nonproductive coughs (lasting less than seven days), some over the counter (OTC) medicines may help. If you have a fever, shortness of breath, chest pain, are coughing up blood, swelling, or any other unusual symptoms, you should talk with your doctor before treating the cough with OTC medicines. Another reason to talk with your doctor prior to self-treating your cough with OTC medicines would be if you have a disease associated with cough, like asthma, COPD (chronic obstructive pulmonary disease), chronic bronchitis, or heart failure.
Over-The-Counter Medicine for Dry Cough
The most common agent used for dry cough is dextromethorphan. Dextromethorphan is the active ingredient in Delsym® or Robitussin®, which are available over-the-counter (OTC). Dextromethorphan is often found in combination products as well. If dry cough is your only symptom, it is not necessary to use a combination medicine, dextromethorphan alone would be sufficient. Dextromethorphan is a non-opioid medication that can help decrease the severity and frequency of the cough. Dextromethorphan may cause drowsiness, so use this medicine cautiously if you need to be alert. Dextromethorphan should not be used OTC for children under 4 years old.
Some coughs may be caused by postnasal drip, which is a condition where secretions from the nose drain down into the throat. Postnasal drip is usually caused by allergies or the common cold. An antihistamine (like diphenhydramine (Benadryl®), chlorpheniramine, dimenhydrinate, or brompheniramine) plus a decongestant (like pseudoephedrine, phenylephrine, or Sudafed®) may help coughs caused by postnasal drip. Antihistamines like Benadryl® tend to cause drowsiness but may cause a ‘paradoxical’ reaction in children and the elderly and cause excitation.
Natural Remedies for Dry Cough
There are non-medicated options available OTC as well. Buckwheat honey is an agent that helps coat the throat and is found in many “natural” cough syrups, Like Matys® and Zarbee’s®. Some cough syrups labeled as honey may also contain dextromethorphan, so read the label on the box to be sure what you’re getting. Do not give honey to children under 12 months of age. Non-medicated lozenges may help with cough symptoms as well.
Prescription Medicine for Dry Cough
In most states, a prescription is required for codeine, but some states still may have codeine available OTC. Codeine is an opiate medication used to treat cough. Codeine also may cause drowsiness, so be cautious with this medication when you need to be alert.
Another option to treat dry cough is benzonatate (Tessalon Perles®), which is available by prescription only. Benzonatate is usually well tolerated without many side effects, but less commonly can cause confusion, dizziness, or drowsiness. If ever you’re unsure about how to treat your cough, talk with your doctor or pharmacist.
1) Chest. 2006 January; 129(1 Suppl): 1S–23S. doi: 10.1378/chest.129.1_suppl.1S.
2) UpToDate®: Silvestri, R.C., Weinberger, S.E. (2017). Evaluation of subacute and chronic cough in adults. In P.J. Barnes & T.E. King Jr. (Eds.), UptoDate. Available from Evaluation of subacute and chronic cough in adults – UpToDate.