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Treating cough

Making the right choice

Medication for cough relief is based on the two principles of protussive (cough-promoting or expectorant) and antitussive (cough-suppressant). When choosing the right remedy, patient-specific factors such as age, allergies or hypersensitivities must be taken into account.
Marta Campbell
06.10.2021  12:30 Uhr

Effervescent tablets or a granulate to dissolve can help to increase the amount of fluid drunk. Patients who complain of a scratchy throat apart from a cough are well advised to use a viscous syrup, juice or lozenges. Their ingredients leave a soothing film on the mucous membrane and relieve the symptoms locally.

For pregnant women, children or dry alcoholics, alcohol-free preparations or tablets are the sensible choice. People who suffer from hypersensitivity may not tolerate some herbal ingredients. For them, a chemical-synthetic remedy may be the better choice.

Phytopharmaceuticals work

Randomised controlled studies of numerous phytotherapeutics have shown that the duration and intensity of acute coughs in colds was reduced as compared to placebo. Preparations with ivy (such as with the ivy dry extract EA 575® in Prospan® cough syrup), cineol (main component of eucalyptus oil, among others, contained for example in Soledum® forte capsules), a mixed distillate of eucalyptus, sweet orange, myrtle and lemon oil l (as in the special distillate ELOM-080®, contained in GeloMyrtol® forte capsules) and Capeland pelargonium (as in the special extract EPs 7630®, contained in Umckaloabo® drops, juice and tablets) have been tried and tested accordingly. There is also good evidence for some combination preparations, for example with ivy and thyme (as in Bronchipret® juice TE) and primrose and thyme (as in Bronchipret® film tablets TP).

To relieve the irritation of the cough, PTA can also recommend phytopharmaceuticals containing mucilage, for example with Iceland moss or marshmallow root. They place a soothing layer of mucus on the cough receptors of the upper respiratory tract. An aqueous extract of Iceland moss in the form of pastilles soothes mucous membrane irritations inside the mouth and throat area. It is contained in tea preparations too. Mucilage from marshmallow root is also a balsam for the sore throat.

Ease coughing up

Expectorants can liquefy highly viscous mucus (mucolytics) or increase the volume of secretion (secretolytics). Patients then find it easier to cough up stiff mucus. For example, ambroxol and bromhexine have been tried and tested for secretolysis and N-acetylcysteine for mucolysis. With all expectorants, the mucolytic effect of the medicine is improved if patients drink a lot throughout the day.

Bromhexine and its metabolite ambroxol are available in numerous dosage forms, including juice, tablets and drops. In rare case, severe skin reactions such as Stevens-Johnson syndrome may occur as an ADR (adverse drug reaction). Patients must then stop treatment immediately and seek medical advice.

N-acetylcysteine also facilitates expectoration in cold-related bronchitis. Adults and adolescents from 14 years of age take 400 to 600 mg of acetylcysteine daily, children from six to 14 years, 400 mg and children from two to five years, 200 to 300 mg.

The active ingredient guaifenesin is more common in English-speaking countries. If centrally depressant preparations or muscle relaxants are inadvertently combined with this active ingredient, its effect can increase in an unpredictable way.

Dampening the irritation

A constant coughing irritation is particularly agonising at night. Antitussives with dextromethorphan make it easier to sleep through the night. The cough blockade sets in after 15 to 30 minutes and lasts for up to six hours with non-retarded preparations. The combined administration of antitussives with expectorants is only possible with a time delay, otherwise the cough blocker will prevent the expectoration of mucus that has already been loosened. Therefore, it is best for patients to take the expectorant until the afternoon at the most, and then use the cough suppressant in the evening.

A classic among the antitussives is dextrometorphan. Its antitussive effectiveness with colds has been confirmed in studies, most of which were financed by manufacturers. Self-medication is limited to a maximum of five days; it is contraindicated for children under six years of age. Inappropriate use may cause symptoms such as respiratory depression, consciousness disorders, hypotension and tachycardia. Moreover, there is also a risk of developing dependence.

Pentoxyverine acts directly in the cough centre of the brain and inhibits the cough stimulus there. Medicines with pentoxyverine are not addictive and do not reduce breathing capacity.

For children between the ages of two and 13, the dosage is based on body weight. Adolescents from 14 years of age and adults take a single dose of 20 to 30 mg of pentoxyverine three to four times a day.

Deutsch/German Englisch/English
Abhängigkeit dependence
Abhusten expectoration
Alkoholiker alcoholic
Antitussiva antitussives
Atemdepression respiratory depression
Atemwege respiratory tracts
Expektoranzien expectorants
Husten cough
Hustenblocker cough suppressant
Hustenstiller cough suppressant
Hustenzentrum cough center
Lutschpastillen lozenges
Rachenraum throat area
Reiz irritation
Schleimhaut mucous membrane
Schleimlöser mucolytic, expectorant
Schwangere pregnant women, expectant mothers

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