Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Tx for Acute Cough Associated with the Common Cold

Chest; ePub 2017 Aug 22; Malesker, et al

Options for the pharmacological and non-pharmacological treatment for acute cough associated with the common cold (CACC) have changed little since the publication of the 2006 CHEST Cough Guidelines, according to a systematic review of randomized controlled trials (RCTs) that sought evidence of clinically relevant treatment effects for therapies in reducing the duration and severity of acute CACC. While the evidence supporting the management of CACC’s is overall of low quality, the expert panel did issue the following recommendations and suggestions:

  • For adult and pediatric patients with cough due to the common cold, there is a suggestion against the use of over-the-counter (OTC) cough and cold medicines unless they have been shown to make cough less severe or resolve sooner (upgraded consensus-based statement).
  • In adult patients with cough due to the common cold, there is a suggestion against the use of nonsteroidal anti-inflammatory agents until they have been shown to make cough less severe or resolve sooner (upgraded consensus-based statement).
  • In pediatrics patients (aged 1-18 years) with cough due to the common cold, honey may offer more relief for cough symptoms than no treatment, diphenhydramine, or placebo, but it is not better than dextromethorphan (upgraded consensus-based statement). Note: Infants less than 1 year of age should not be administered honey and children less than 2 years of age should not be administered dextromethorphan for cough symptoms.
  • In pediatrics patients with cough due to the common cold, codeine-containing medications should not be used because of the potential for serious side effects including respiratory distress (upgraded consensus-based statement).
  • The authors found no evidence to support or refute the use of OTC antitussives, expectorants, mucolytics, antihistamines, or combination products.

Citation:

Malesker MA, Callahan-Lyon P, Ireland B, Irwin RS, for the CHEST Expert Cough Panel. Pharmacological and non-pharmacological treatment for acute cough associated with the common cold. [Published online ahead of print August 22, 2017]. Chest. doi:10.1016/j.chest.2017.08.009.

Commentary:

Voltaire said, “The art of medicine consists in amusing the patient while nature cures the disease.” Nowhere is the wisdom of this approach more apparent than in the treatment of the common cold. Nearly $10 billion a year is spent on treatments for OTC cough, cold, and allergy products.1 While many OTC medications have been extensively studied and provide great benefit for the relief of allergic symptoms, the same cannot be said for medications for viral-induced cough. Based on the evidence, decaffeinated tea and honey seems to make sense, but there is little evidence to recommend much else. And, in 2008, the FDA released a Consumer Update strongly recommending that “over-the-counter (OTC) cough and cold products should not be used for infants and children under 2 years, and in 2015 the FDA recommended against the use of codeine-containing medications in those under 18."2,3—Neil Skolnik, MD

  1. Johnson M. Cough-Cold Report 2016. Drug store news. February 2016. http://www.drugstorenews.com/sites/drugstorenews.com/files/CoughCold_ 020816.pdf. Accessed August 28, 2017.
  2. OTC cough and cold products: Not for infants and children under 2 years of age. FDA Consumer Update. Posted January 17, 2008. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048682.htm.
  3. Ostroff C, Lee CE, McMeekin J. Unapproved prescription cough, cold, and allergy products. Recent US Food and Drug Administration regulatory action on unapproved cough, cold, and allergy medications. Chest. 2011;140:295-300.

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