Cough and congestion

Question 1

Cough suppressants

Answer 1

• Cough suppressants include Codeine, Pholcodeine and Dextromethorphan.
• They are useful in patients whose sleep is disturbed but may lead to sputum retention which can worsen COPD.
• Codeine may be effective, but it is constipating and can cause dependence
• Dextromethorphan and Pholcodeine have fewer side effects
• Sedating antihistamines are used as the cough suppressant component of many cough preparations. All tend to cause drowsiness which may reflect on their mode of action.

Question 2

Demulcent and Expectorant cough preparations

Answer 2

 Demulcent cough preparations contain soothing substances such as syrup or glycerol. It is unlikely they actually work but simple linctus and paediatric simple linctus are harmless.
 Expectorants such as Guaifenesin promote the expulsion of bronchial secretions.
 Compound preparations are available on sale to the public for the treatment of cough + colds but should not be used in children under 6 years.

Question 3

Oral decongestants

Answer 3

• Oral decongestants (e.g. Pseudoephedrine) are probably less effective than topical decongestants but they have the advantage of not causing rebound congestion.
• Decongestants should be used in caution in patients with diabetes, hypertension, hyperthyroidism and AVOIDED in patients taking Monoamine-Oxidase Inhibitors.

Question 4

Cough preparations in children

Answer 4

• Children under 6 should not be given any cough or cold medicine containing antihistamines (i.e. chlorphenamine, promethazine), cough suppressants (dextromethorphan, pholcodeine), expectorants (i.e. guaifenesin) or decongestants (i.e. pseudoephedrine, phenylephrine, oxymetazoline or xylometazoline)
• Codeine should be avoided in children under 12; dextromethorphan and pholcodine are similarly not recommended but should only be avoided in children under 6 years.
• OTC cough + cold medicines can be considered for children aged 6-12 years, but treatment should be limited to 5 days. Children should not be given more than 1 cough or cold preparation at a time, because different brands may contain the same active ingredient, care should be taken to give the correct dose.

Question 5

Aromatic inhalations in children

Answer 5

• The use of strong aromatic decongestants (applied as rubs or to the pillows) is not advised for infants under the age of 3 months.
• Infants in whom nasal obstruction with mucus is a problem can be given Sodium Chloride 0.9% nasal drops. Administration before feeds may ease feeding difficulties caused by nasal congestion.