What this protocol covers
The cough that reaches the counter in an adult: telling a dry cough from a chesty one, what fits each, and when a cough is a sign of something else.
1. What to ask
- Is it dry or does it bring up phlegm? What colour is it?
- How long have they been coughing, and did it start with a cold?
- Do they have a fever, are they short of breath, wheezing or in pain when breathing?
- Do they smoke? Do they have asthma, COPD or heart failure?
- What medicines do they take? Some blood pressure medicines (ACE inhibitors such as enalapril) cause a dry cough.
2. Refer if any of these appear
- A cough lasting more than 3 weeks.
- Blood in the phlegm.
- Shortness of breath, wheezing, chest pain or blue lips.
- A high fever for more than 3 days, or getting worse after starting to improve.
- Weight loss or night sweats, or a new dry cough since starting an ACE inhibitor (see the doctor, without stopping it on their own).
3. If there are no red flags
A dry, tickly cough that stops them sleeping
- Dextromethorphan at the dose in the leaflet, especially at night. Check first that they are not taking serotonergic antidepressants (SSRIs, MAOIs).
- A spoonful of honey soothes a cough and has evidence behind it.
- Drinking fluids and keeping the air humid.
A chesty cough
- It is not suppressed: the cough is clearing the phlegm.
- What helps most is drinking fluids. A mucolytic (acetylcysteine, ambroxol) offers a small benefit.
- Never a cough suppressant and a mucolytic together: the phlegm loosens and cannot be cleared.
In any case
- Stopping smoking, or at least not smoking indoors.
- A cough from a cold can last up to 3 weeks: worth saying so that they do not keep buying syrups.
4. Adjust to who will take it
- Pregnancy
- Honey, fluids and humidity. Cough suppressants and mucolytics only on medical advice; codeine never on their own initiative.
- Children
- In children, cough suppressants and mucolytics are not recommended without a doctor: mucolytics are contraindicated under 2 and cough suppressants are not advised under 6. Honey from age 1.
- Asthma
- A cough with wheezing or that is making their asthma worse is not one for a syrup: their doctor should assess it.
- Long-term conditions
- With COPD or heart failure, a new cough or more tiredness than usual should be checked by their doctor.
What not to recommend
- Codeine without a prescription: it needs one, and it is contraindicated under 12 and while breastfeeding.
- A cough suppressant and a mucolytic together.
- Antibiotics: they need a prescription and do not help a viral cough.
- Dextromethorphan with SSRIs or MAOIs, because of the risk of serotonin syndrome.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: cough
To print and hand over. It carries only what the patient needs at home.
- Drink fluids often and keep the house aired and slightly humid.
- A spoonful of honey can soothe a cough (not under 1 year of age).
- Do not mix a syrup for a dry cough with one for phlegm.
- See your doctor if the cough lasts more than 3 weeks, if you are short of breath, if your chest hurts or if there is blood.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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The suppressant stops the phlegm loosened by the mucolytic from being cleared. In a chesty cough, what helps most is fluids.
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ACE inhibitors cause a dry cough in some patients. Her doctor assesses it; stopping it on her own leaves her blood pressure untreated.
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A cough from a cold can last up to 3 weeks; beyond that, or with these signs, a doctor assesses it.
Training content. It does not replace the summary of product characteristics or clinical judgement.