Cough Management Guidelines

Introduction to Cough Suppressant Options

The American College of Chest Physicians recommends using dextromethorphan 60 mg or peripheral cough suppressants like levodropropizine for chronic or acute bronchitis, and ipratropium bromide for URI-related cough, while avoiding central suppressants like codeine due to its worse side effect profile 1, 2

For chronic or acute bronchitis, first-line options include dextromethorphan at 60 mg for maximum cough reflex suppression, and peripheral cough suppressants like levodropropizine and moguisteine for short-term symptomatic relief with substantial benefit 1, 4
Ipratropium bromide is the only inhaled agent recommended for cough suppression in chronic bronchitis and URI, and should be tried before central antitussives in postinfectious cough 1, 4
For URI-related cough, simple home remedies like honey and lemon may be as effective as pharmacological treatments and should be tried first, while ipratropium bromide is the only recommended agent 1, 4

Dextromethorphan has an optimal dosing of 60 mg for maximum cough suppression, and has a superior safety profile compared to opioid alternatives, but should not be used for productive cough where secretion clearance is beneficial 2, 3
Codeine is not recommended as first-line due to adverse effects without superior efficacy, and causes drowsiness, nausea, constipation, and risk of physical dependence 1, 4, 2

Albuterol is not recommended for acute or chronic cough not due to asthma, and mucolytics are not recommended for chronic bronchitis cough suppression 1, 4
Drugs affecting the efferent limb of the cough reflex, and protussive pharmacologic agents in neuromuscular impairment are also not recommended 1, 4

Using subtherapeutic doses of dextromethorphan, prescribing codeine-based antitussives, using central cough suppressants for URI-related cough, and applying cough suppressants to productive cough where secretion clearance is needed should be avoided 1, 4, 2, 3