Is your cough medicine right for you?

A lingering, tickly cough whether due to a cold or other condition can be a common and annoying symptom of various illnesses; including colds, flu, allergies, and upper respiratory tract infections (URTI). 

While a cough often serves as the body’s natural reflex mechanism to clear irritants such as dust, smoke, and mucus from the airways, if not treated right, can be persistent and disruptive. In such cases, cough medicines come in handy as it provide relief and shorten the recovery period. 

However, with what seems like hundreds of brands of cough medicines available in the market, ranging from traditional to western cough medicine, choosing the right cough medicine can be overwhelming and confusing. How do you choose the best, appropriate cough medicine for your situation?

Understanding the different types of cough

Before choosing a cough medicine, it's important to understand the nature of your cough. Depending on the duration of your cough, it can be acute if it lasts around 2-3 weeks or it can be chronic if it lasts longer than 3 weeks which can be caused by conditions such as asthma, chronic bronchitis, allergies, chronic obstructive pulmonary disease (COPD), smoking etc.

More specifically, coughs can be broadly categorized into two types: dry and productive (wet).

Dry cough (unproductive cough): This type of cough is often accompanied by a tickling or irritating sensation in the throat that doesn’t produce any mucus. Inflamed or irritated airways can cause dry cough and they are typically seen in people who have allergies, sinusitis (post-nasal drip cough), asthma, GERD-induced cough, or ACEI (a medicine used to treat hypertension) induced cough. 

Wet cough (productive cough): Characterized by the production of mucus or phlegm and may be accompanied by a wheezing sound. A wet cough generally helps to expel excess mucus from the airways and lungs, preventing buildup that can affect breathing. They often occur in respiratory infections like bronchitis, pneumonia, flu, etc.

Choosing the right cough medicine

In the same way that there are different types of coughs, there are also different types of over-the-counter cough medicines catered to treat your symptoms accordingly. Cough medicines usually contain one or more active ingredients, below are the most typical ones and their indications:

1. Antitussives: Also known as cough suppressants, antitussives block the cough reflex by decreasing activity in the part of the brain that causes coughing.
   Examples of antitussives that can be found in Malaysia are Dextromethorphan (Cough-en linctus, Pharmaniaga Dextromethorphan)

2. Expectorants: Works by thinning mucus, which in turn aids congestive chesty coughs to expel phlegm and subsequently clear the airway.
   Examples: Guaiphenesin (Breacol), Ammonium chloride (Bena expectorant, Uphadyl forte)

3. Mucolytic agents: Aids mucus expulsion by thinning and loosening mucus in the airway. It acts by decreasing the viscosity of mucus in the airway, hence enhancing mucus clearance.
   Examples: Acetylcysteine (Fluimucil), Carbocisteine (Pabron), Bromhexine (Bislan), Ambroxol (Mucosolvan)

4. Decongestants: Widens the airway and relieves cough associated with a blocked nose through reduction of mucus production and ease of breathing.
   Examples: Pseudoephedrine (Mendicof, Cough-en linctus, Sedilix dm linctus)

5. Antihistamines: Alleviate cough associated with allergies or postnasal drip with symptoms including runny nose or sneezing as it dries up the secretions from mucous membranes. It is often combined with other active ingredients in cough syrup such as decongestants, expectorants, or other antihistamines depending on the type of product. One of the downfalls of antihistamine cough preparations is it may cause drowsiness and hence would not really be encouraged to be taken during the time.
   Example: Diphenhydramine (Pharmaniaga, Bena Expectorant)

Is cough medicines safe for everyone? 

Cough medicines are typically safe for most adults, but NPRA has still not approved OTC cough medicines for anyone under the age of 2 as their side effects may be potentially life-threatening to babies. Most pregnant women can also safely use the cough medicines mentioned above except those with decongestant properties, but it is still wise to get advice from your pharmacists or doctors. 

Home Remedies for Cough 

Parents of children under 2 or those in search of more natural cough remedies can opt to explore the following home remedies for cough:

•  Honey that naturally serves as a demulcent to soothe irritating throat
•  Hot ginger, thyme, peppermint tea
•  Saltwater gargle
•  Avoid or minimize spicy, deep-fried food, cold beverages for the time being
•  Suck on ice cubes for dry throat
•  Stay hydrated at all times

Additionally, one may use steam inhalation or use extra pillows to elevate the head and upper body. This can help prevent post-nasal drip which can lead to nighttime coughing. Common throat lozenges like Difflam or Strepsils play a role in reducing cough and aid with sore throat as they keep your throat moist and relieve inflammation (if any).

Conclusion

Coughs are usually self-limiting and can heal on their own if mild. The treatment available is aimed at alleviating and providing effective relief for those who feel uncomfortable throughout their cough duration. Thus, choosing the right cough medicine is essential for effective relief. By considering your cough type, reviewing active ingredients, evaluating your specific symptoms, and consulting with a healthcare professional when needed, you can ensure that your cough medicine is the right fit for you. Don't let a persistent cough disrupt your well-being; make an informed choice for a quicker and more comfortable recovery. 

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US),
reviewed by Dr. Lee Siew Ling, MD (DOC2US). 

References 

1.  http://www.myhealth.gov.my/en/cough-and-cold/ 
2.  https://www.verywellhealth.com/choosing-over-the-counter-cough-medications-770663 
3.  https://www.forbes.com/health/body/best-cough-medicine/ 
4.  https://lifemd.com/learn/best-otc-cough-medicine-how-do-i-choose-the-right-option-for-me 

Written by

Janelle Leong, Bpharm(Hons) DOC2US