How toTreat a Cough in an Adult

Feb 10, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Early 40s. Mostly bald. Glasses. Quite a pronounced spare tire. No, this isnt the worlds worst online dating profile. But if I was a character in a movie or TV show Id be one of two things. Id either be the hopelessly confused, oblivious and stupid father/husband or the serial killer. Ive heard people complain that it isnt fair that all dads or fathers in Hollywood scripts seem to be buffoons. That really doesnt bother me. I like that Hollywood sets the bar very low. The fact I can change a diaper, make a meal and tie my own shoes makes me a superhero compared to my fictitious counterparts. The serial killer thing is giving me more of a complex, though. I like crime dramas like Criminal Minds. But the bad guy is always the same. He (and it is almost always a he) is a white guy in his late 30s to early 40s. He is overweight and socially awkward. He has a wife, children and a job, but on weekends he commits horrible crimes. He usually has medical training that helps him commit these crimes. However, no one suspects him because he is such a nice, quiet guy. The profiles of these fictitious serial killers keep sounding way too much like me. I know Hollywood has types. The good looking guy in his 20s is the leading man, and the woman in her 60s is the kindly grandmother. I find it quite disturbing that, according to Hollywood, Im in the serial killer phase of my life.

In the pharmacy I can debunk the Hollywood sterotype easily. Come ask me about what to take for a cough. Im pretty confident in the cough and cold aisle. What kind of cough do you have? A dry cough lets get you a cough syrup with dextromethorphan or DM in it. A wet cough lets go for guaifenesin. It is an expectorant which will help liquefy the mucus and let you cough it out easier. Im confident, because Ive been telling this story to adults with a cough since I left pharmacy school. The experts though are less confident that these are effective treatments.

There is debate whether DM and guaifenesin help adults with a cough due to the common cold at all. Before we get into that, lets start with who should not stop in the cough and cold aisle. If you are an adult and you are coughing but you have thick colorful mucus and a fever above 39.4 C (or 103 F), go see your doctor. If you have shortness of breath, chest pain, you are coughing up blood in your phlegm, have chills, night sweats or blue skin go see your doctor about your cough. If you have weight loss, rash, long lasting headache, asthma, COPD or heart failure, go directly to see your doctor about your cough. Dont stop in the pharmacy.

What should you do if you are an adult and have an uncomplicated cough? If your cough is due to a common cold, DM mixtures and guaifenesin mixtures might help, but the evidence from clinical trials is sparse at best. Get your pharmacist to recommend a first generation antihistamine and a decongestant. These medications have the best evidence that they will work on a cough due to a cold in an adult. The recommendation of a first generation antihistamine like Benadryl or diphenhydramine surprised me. Although we use first generation antihistamines for allergic reactions like poison ivy, swimmers itch and bug bites, they make people sleepy. That makes them less popular than the second generation like cetirizine or reactine and loratidine or Claritin. However, second generation antihistamines are not shown to be effective against cough due to colds while first generation ones are. Decongestants decrease the amount of mucus in the nose and throat and have evidence to show they help coughs due to colds and due to post nasal drip. You have to be a little careful with decongestants if you have high blood pressure. Decongestants can make blood pressure go up, so discuss your blood pressure with your pharmacist before you take one.

The other surprising recommendation for coughs was the prescription NSAID naproxen. Naproxen will reduce the inflammation in the nose and nasal passages. It will also help calm the cough provoking nerves. So prescription naproxen can also be used to treat a cough due to cold. The cautions with naproxen include it can promote stomach ulcers and increase blood pressure in people with certain kidney conditions.

Other surprises included: cough candies or lozenges are not recommended at all as they dont seem to do anything. Zinc will not help a cough. The prescription inhaler called salbutamol or Ventolin apparently will not help treat a cough due to the common cold. However, it is very useful if the cough is due to asthma.

Do these changes in what Ive recommended for cough due to colds shake my confidence? No. I think it is great that medical knowledge is always evolving. What if you have always used Benylin DM for your cough and have always liked it? No problem. The recommendations dont say it is harmful or wont work. They say there just isnt much evidence of benefit. What if you dont want anything from the pharmacy at all for your cough due to a cold. No problem there either. Honey coats the throat and may calm a cough. Go make some nice lemon tea and put a big tablespoon or two of honey in it.

Maybe I shouldnt let the fact that my fictitious TV and film contemporaries are serial killers shake my confidence. If I was an actor, I guess playing a serial killer would be more interesting than playing a dumb dad. The other thing that should give me confidence is my profession. Although many TV serial killers seem to have medical backgrounds, they are never pharmacists. They are nurses, home care aides, EMTs and the most common TV medically trained serial killers seem to be doctors. I guess Hollywood screen writers just recognize us pharmacists as the kind, caring health care professionals that we really are.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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Diagnosis and Management of Cough Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines

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