New Cough Guidelines Recommend Against OTC Medications

New evidence-based guidelines issued by the American College of Chest Physicians (ACCP) provide the most comprehensive recommendations for the diagnosis and management of cough in adults and children, including specific recommendations for the prevention of whooping cough in adults. Diagnosis and Management of Cough: Evidence-Based Clinical Practice Guidelines is published as a supplement to the January issue of CHEST, the peer-reviewed journal of the ACCP. “Cough is the number one reason why patients seek medical attention. Although an occasional cough is normal, excessive coughing or coughing that produces blood, or thick, discolored mucus is abnormal,” said Chair of the guidelines Richard S. Irwin, MD, FCCP, University of Massachusetts Medical School, Worcester, MA “The new ACCP guidelines define how physicians should diagnose and manage cough associated with everything from the common cold to chronic lung conditions. The guidelines also are the most comprehensive evidence-based recommendations for treating cough in children.” The ACCP cough guidelines put new emphasis on the prevention of whooping cough in adults and address the role of over-the-counter (OTC) cough medications in both adults and children. The guidelines also include more than 200 recommendations for diagnosing and managing acute cough (a cough that lasts for less than 3 weeks), subacute cough (a cough that lasts 3 8 weeks), and chronic cough (a cough that lasts for more than 8 weeks) in adults and children. WHOOPING COUGH The guidelines strongly recommend that adults up to 65 years old receive a new adult vaccine for whooping cough (pertussis), a highly contagious type of subacute cough that gets its name from the loud “whooping” noise patients make when they cough. Because antibiotics are only effective early on in the infection, preventing whooping cough with a vaccine is the only way to eventually eliminate the disease. Once whooping cough takes hold, the coughing patient is at risk of serious complications of coughing, such as vomiting, breaking ribs, passing out, and passing the infection on to others. “Most of us think of whooping cough as a childhood disease, yet 28 percent of whooping cough cases in the United States is in adults,” said Dr. Irwin. “Although most of us were vaccinated against whooping cough when we were children, the older vaccine only gives protection for less than 10 years. Because the older vaccine caused serious side effects when given to older children and adults, it was only given to children. Fortunately, there is a now a new safe and effective whooping cough vaccine that can prevent adults from contracting this disease.” OTC COUGH MEDICATION The guidelines also stress that most over-the-counter cough expectorants or suppressants, including cough syrups and cough drops, do not treat the underlying cause of the cough. Therefore, the guidelines recommend that for adults with acute cough or upper airway cough syndrome (previously named postnasal drip syndrome), an older variety antihistamine with a decongestant is the preferred therapy. “There is no clinical evidence that over-the-counter cough expectorants or suppressants actually relieve cough,” said Dr. Irwin. “There is considerable evidence that older type antihistamines help to reduce cough, so, unless there are contraindications to using these medicines, why not take something that has been proven to work?” PEDIATRIC RECOMMENDATIONS The ACCP guidelines are the first to provide comprehensive, specific, evidence-based recommendations for the diagnosis and management of cough in children. Although the guidelines address all types of pediatric cough, they make a strong recommendation against the use of OTC cough and cold medications for children age 14 years and younger. “Cough is very common in children. However, cough and cold medicines are not useful in children and can actually be harmful,” said Dr. Irwin. “In most cases, a cough that is unrelated to chronic lung conditions, environmental influences, or other specific factors, will resolve on its own.” Of the estimated 829 million visits to office-based physicians in the United States, approximately 29.5 million are for cough. Additional recommendations address the most common causes of chronic cough, including upper airway cough syndrome (previously named postnasal drip syndrome), asthma, and gastroesophageal reflux disease (GERD). Chronic cough also may be a result of smoking or taking angiotensin-converting enzyme (ACE) inhibitors. An acute cough is generally caused by a “common cold”; a subacute cough can linger after a cold or may persist due to a respiratory tract infection, such as whooping cough or other postinfectious cough. “Chronic cough can significantly compromise quality of life for patients. However, patients with chronic cough do not have to continue suffering from their condition,” said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians. “The new ACCP guidelines provide clinicians with proven methods of identifying and treating the underlying causes of chronic cough, ultimately, leading to more effective management of chronic cough and better quality of life for patients.” Endorsed by the American Thoracic Society and the Canadian Thoracic Society, the new ACCP cough guidelines were developed by an international committee of individuals with expertise and research experience related to cough from the fields of adult and pediatric pulmonology and respirology, pharmacology, neurology, speech and swallowing, and anatomy and physiology. CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at: