Page 127 - Community pharmcy practice E-book 2025

02/11/2025, 00:29

Pharmacological Treatment
• OTC options aimed at symptomatic relief rather than curing cause. Evidence for many
cough-specific OTC products is limited.
• For dry (tickly) cough: antitussives such as dextromethorphan (in adults/older children)
may be considered.
• For productive cough: expectorants like guaifenesin are available but their benefit is
modest and evidence is weak.
• For cough due to allergic/post-nasal drip: antihistamines/decongestants may help if
underlying cause is appropriate. However, evidence is variable.
Important safety cautions: OTC cough/cold products are not recommended for children under a
certain age (varies by country) due to risk of serious adverse effects.
Codeine or other opioid-based cough syrups have significant risks (especially in children, ultra
rapid metabolizers) and are not appropriate for many cases.

Pharmacist role: choose appropriate product based on cough type, patient age/comorbidity,
monitor for contraindications, check for overlapping ingredients in combination products,
counsel on dose, duration, when to discontinue and when to refer.

Patient Counselling Tips
• Explain that cough is often a reflex to clear airways and in many cases (especially viral) will
resolve on its own over days to a couple of weeks. Setting expectations helps.
• Ask screening questions: “How long have you had the cough? Is it dry or productive? Is
there fever, weight loss, blood, smoking history? What triggers it? Are there other medical
conditions/medicines (e.g., ACE inhibitors)?” This helps determine self-care vs referral.
• If recommending OTC product: show how and when to take it; emphasise age-appropriate
use; correct dosing; duration (if no improvement, come back).
• Advise non-drug measures (hydration, humidity, avoid irritants, rest, throat soothing)
alongside medication.

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