Cough Management

Expectants and Mucokinetic Agents

The American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines indicate that guaifenesin decreases subjective measures of cough due to upper respiratory tract infections (URIs) and both subjective and objective indexes of cough due to bronchiectasis 1
The ACCP guidelines indicate that mucokinetic agents have not shown consistent favorable effects in acute bronchitis 2
For chronic bronchitis, the ACCP states that "there is no consistent favorable effect of mucokinetic agents on cough" 2
Other options that have been studied include iodinated glycerol, bromhexine, carbocysteine, and acetylcysteine, although they are not approved or have limited effectiveness in the US 1
For symptomatic relief of cough without expectoration goals, patients may benefit from cough suppressants like dextromethorphan, first-generation antihistamines, or β-agonists, though data supporting specific therapies are limited 3

Guaifenesin has a well-established and favorable safety and tolerability profile in adult and pediatric populations, with fewer side effects compared to antitussive agents like codeine 1