February 18,2006

      The American College of Chest Physicians recently issued new guidelines on the treatment of coughs that discourage the use of traditional cough syrups.  This view directly contradicts the evaluations of the FDA which supported their safety and effectiveness. When two respected sources conflict, patients only get confused.

As a pulmonologist, I believe that there is no one size fits all answer to the treatment of coughs. A remedy must be based both on severity and cause. If the cough is due to a simple cold, relief should start by gargling with warm saltwater . When a cold or flu virus strikes, the body mounts a defense that includes the production of inflammatory compounds known as cytokines.  These chemicals, which include prostaglandins, and interleukins, are responsible for fever, body aches and that irritating tickle that triggers a cough. Gargling with warm salt water dissolve cytokine laden mucus that lines a cold-affected throat. A cup of hot tea with honey and lemon also can clear the throat of cytokines while providing a healthy supply of disease fighting anti-oxidants.

Even a simple sugar based cough drop contains demulcents that coat a virus- irritated throat, short circuiting the cough reflex. Keep in mind that all of these simple remedies provide affordable and safe relief without adding unnecessary medications to your system.

If the cold or flu is accompanied by heavy congestion and increased mucus production, the cough is triggered by the body’s efforts to clear  the airways. In this situation, you don’t want to mask the cough response. Instead, the solution is to discourage mucus production with old fashioned antihistamines such as Benadryl and Chlorpheniramine. The newer non-sedating antihistamines which work beautifully for allergies, do not have the same impact when the congestion is caused by a cold or flu virus. Antihistamines are frequently used in over the counter combination cold and flu remedies. In fact, a number of these products base their cough control properties on the inclusion of antihistamines in their formulas.

If a cough lingers for more than 10 days, you may have developed as asthma-like irritability of the airways. The original viral infection has damaged the lungs as that they remain inflamed and irritated.  Substances in the environment that once did not cause problems (ie cigarettes, smoke, perfume, pets or even cold air) now provoke contraction of the airways causing you to cough. I have found that the most effective way to control this type of cough is with a mild bronchdilator.  They work almost instantly to quell the cough for hours. Bronchdilators are available only by prescription, and need to be taken for up to six weeks following a bad cold or flu.