Updated Guidelines for Managing Acute Coughs Associated with the Common Cold

Introduction to Common Colds

In November 2017, the American College of Chest Physicians (CHEST) revised their recommendations for managing acute coughs linked to the common cold. On average, individuals experience a cold at least once each year. As the common cold is primarily caused by a virus, antibiotics are ineffective, necessitating alternative symptom management strategies. Common symptoms include a runny nose, sore throat, body aches, and low-grade fever, with coughing often being the most persistent and bothersome.

Popularity of Over-the-Counter Cough Remedies

Since CHEST’s last guideline update in 2006, there has been a notable increase in the use of over-the-counter (OTC) cough and cold remedies among the American population. In 2015, Americans spent over $9.56 billion on these products, with cough syrups and throat lozenges being the most favored options.

Reviewing and Updating Guidelines

With the rise in OTC remedy popularity, CHEST reviewed relevant studies to assess advancements in treatments for the common cold. Their focus was on determining whether new treatment options could effectively reduce the severity or duration of coughs associated with the illness. The updated recommendations were categorized based on treatment types: antihistamines and decongestants, acetylcysteine and carbocysteine, honey, zinc lozenges, nonsteroidal anti-inflammatory drugs (NSAIDs), and OTC cough and cold medicines. The revised guidelines were published in 2017.

Effectiveness of Honey for Cough Relief

The review indicated that honey might provide superior relief from coughing in children aged 1-18 years compared to the antihistamine diphenhydramine or no treatment. While the OTC medicine dextromethorphan was found to be more effective than honey, it should not be administered to infants under two years of age.

Treatment Options Not Recommended

Conversely, the team advised against the use of decongestants, antihistamines, NSAIDs, or OTC cough and cold medicines for both adults and children, citing limitations in the evidence they evaluated. Many OTC products contain active ingredients that pose serious risks if misused, prompting the recommendation that medicines containing codeine should not be given to children under 18 years. Additionally, the use of zinc lozenges was discouraged due to potential side effects.

Insufficient Evidence for Certain Treatments

The team found insufficient evidence to endorse or oppose the use of acetylcysteine or carbocysteine for treating coughs associated with the common cold, resulting in no specific recommendations.

Future Directions for Research and Guidelines

The team is continually monitoring new literature and noted the introduction of several new products since the 2006 guidelines. However, many of these products are merely combinations of existing treatments rather than innovative solutions. They emphasize the need for more high-quality clinical trials to validate the efficacy of common cold treatments and advocate for the development of safe and effective medications for both children and adults.

Reference

Malesker MA, et al. Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold. Chest. 2017; 152:1021-1037.