Medicine for coughing
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Effective Medications for Cough: A Comprehensive Review
Over-the-Counter (OTC) Medications for Acute Cough
Effectiveness in Adults and Children
Acute cough, often resulting from upper respiratory tract infections (URTI), is commonly treated with over-the-counter (OTC) medications. However, the effectiveness of these treatments remains uncertain. Studies have shown mixed results for various OTC medications. For instance, antitussives like codeine and dextromethorphan have shown variable effectiveness, with some studies indicating no significant benefit over placebo . Expectorants such as guaifenesin have also shown inconsistent results, with some trials indicating benefit while others do not . Mucolytics have shown some promise in reducing cough frequency and symptom scores in adults . Antihistamine-decongestant combinations and other drug combinations have also shown conflicting results .
In children, the effectiveness of OTC medications is even less clear. Studies have generally found that antitussives, antihistamines, and antihistamine-decongestant combinations are no more effective than placebo . Mucolytics and certain pediatric cough syrups have shown some benefit, but the evidence is limited .
Safety and Adverse Effects
The safety profile of OTC medications is generally acceptable, with most studies reporting a low incidence of minor side effects such as nausea, vomiting, headache, and drowsiness . However, the overall quality of evidence is low, and higher-quality studies are needed to draw definitive conclusions.
Herbal and Traditional Medicines
Maekmoondong-tang (MMDT)
Maekmoondong-tang (MMDT), a traditional herbal medicine used in Korea, Japan, and China, has shown potential in reducing cough severity. A systematic review and meta-analysis found that MMDT reduced cough severity by 74% compared to conventional antitussive medications. However, the evidence is inconsistent for its effectiveness in conditions like chronic obstructive pulmonary disease and asthma, and the methodological quality of the studies is generally poor.
Licorice Pastille
Licorice pastille, a traditional Persian medicine, has shown promise in treating chronic cough. A randomized, double-blinded, placebo-controlled trial found that licorice pastille significantly reduced cough severity and improved quality of life compared to placebo. No major side effects were reported, making it a potentially safe option for chronic cough management.
Chinese Herbal Medicine
Chinese herbal medicine (CHM) has been studied for its effectiveness in treating chronic cough, particularly cough variant asthma (CVA). Preliminary evidence suggests that CHM, when used alongside conventional anti-inflammatory medications, may improve cough severity and quality of life. However, high-quality evidence supporting its long-term efficacy is still lacking.
Honey for Acute Cough in Children
Honey has been traditionally used to alleviate cough symptoms in children. Studies have shown that honey may be more effective than no treatment, diphenhydramine, and placebo in reducing cough frequency, but it is not superior to dextromethorphan. Adverse events are generally mild, making honey a relatively safe option for managing acute cough in children.
Medications for Emergence Coughing Post-Anesthesia
Emergence coughing after general anesthesia can be harmful, and various medications have been studied to mitigate this issue. A network meta-analysis found that dexmedetomidine, remifentanil, fentanyl, and lidocaine (via various routes) are all effective in reducing moderate to severe emergence coughing compared to placebo. Dexmedetomidine was ranked the most effective, followed by remifentanil, fentanyl, and lidocaine.
Conclusion
The effectiveness of various medications for treating cough varies widely, with OTC medications showing mixed results and traditional herbal medicines like MMDT and licorice pastille showing some promise. Honey is a safe and potentially effective option for acute cough in children. For emergence coughing post-anesthesia, dexmedetomidine appears to be the most effective medication. However, the overall quality of evidence is low, and more high-quality, placebo-controlled trials are needed to establish definitive treatment guidelines.
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