Cough Medicine: Should You or Shouldn’t You?
Coughs send more people to the doctor's office than most other specific symptom, according to experts. And Americans spend billions of dollars every year on over-the-counter medications to fight coughs, such as cough suppressants and expectorants.
Clearly we're concerned about our coughs. Clearly we rely on cough medication. What's unclear is the answer to this core question: Do cough medicines work?
"We've never had good evidence that cough suppressants and expectorants help with cough," says Norman Edelman, MD, chief medical officer at the American Lung Association. "But people are desperate to get some relief. They're so convinced that they should work that they buy them anyway."
Should you take cough medicine? Here's what you need to know about the pros and cons of common cough medicines.
Cough Medicine: The Evidence
Coughs cause a lot of misery. According to research:
- Coughs are the reason for more than 30 million doctor visits every year.
- By some estimates, coughs are the most common medical symptom.
- Studies show that acute and chronic coughs reduce a person's quality of life.
We're desperate for an effective cough treatment. However, we don't seem to have one. No new licensed cough treatment has appeared in more than 50 years -- and the evidence for older drugs is not strong.
- A 2010 review of studies found that there is no evidence to support using common over-the-counter drugs for cough. This includes cough suppressants, such as dextromethorphan, or expectorants such as guaifenesin, which are supposed to loosen up mucus in the airways.
- In 2006, the American College of Chest Physicians surveyed a number of cough medicine studies from the last few decades. It found no evidence that these medicines help people with common coughs caused by viruses.
It's important to understand that these studies have not proven that cough medicines don’t work. Rather, they’ve just found no proof that they do. It’s always possible that further studies could show that they help.
Cough Medicine and Children
Because of a lack of good evidence that cold and cough medicines help -- and a very small risk of serious side effects -- the FDA stated in 2008 that toddlers and babies should not use cold and cough medicines. Drug makers voluntarily changed the labeling of OTC cough and cold products, recommending them only for children aged 4 and older.
The American Academy of Pediatrics went further, saying that there's no reason that parents should use them in children under age 6.
Unfortunately, a recent survey suggests that parents aren't listening to the warnings. In a nationwide poll, more than 60% of parents with children under age 2 said they have given their kids cold or cough medicine.
Why Do We Use Cough Medicine?
Why would these medicines be so popular if they don't work very well? People find them reassuring, says John E. Heffner, MD, a pulmonologist at the Providence Portland Medical Center in Oregon and past president of the American Thoracic Society.
When we’re sick with a cough -- or worse, when our children are sick -- we’re desperate to do something, anything, to relieve it. Knowing that there’s a medicine we can use makes us feel more in control. People may also start feeling better a few days after taking a cough medicine, so they assume it's working. In fact, Edelman says, the cough may just going away on its own. The medicine may have little to do with it.
Many assume that the FDA wouldn't allow companies to sell drugs that don't have good evidence. That's true for new drugs, Heffner says. But the FDA doesn't routinely reevaluate drugs that were approved long ago. Since cough medicines have been around for decades, they're unlikely to go away.
Are Cough Medicines Safe for Adults?
Although experts agree that young children should not take cough medicine, they may be safe for older children and adults. The odds of serious side effects are very small, Edelman says.
Heffner says that anyone with a cough that lasts longer than five to seven days -- or is accompanied by other symptoms, like a fever or rash -- should also see a doctor. Self-treating a lingering cough is not a good idea.
People should be careful not to overuse the drugs in cough and cold medicines. This can happen accidentally. A person may take more than one brand of cold and cough medicine without realizing that both contain the same ingredients. Or a person may take multiple doses because the first dose didn't help. Edelman cautions: If one dose doesn't help, more doses won't help. Instead, you'll put yourself at risk of an overdose.
Should You Use Cough Medicine?
Experts say that although cough medicine may not help a lot, there's usually little harm in older children and adults using cough medicine.
There may be certain situations in which a doctor would suggest it, Heffner says. "I consider a cough suppressant in some patients who have a chronic cough that hasn't responded to other treatments," he tells WebMD.
If you're wary of using OTC cough treatments but want to try something, consider a little honey in warm tea. Some studies have found that honey is a mildly effective treatment for cough. Honey is not safe for children under age 1, however.
There is one last thing to consider before deciding whether to use cough medicine. Coughing can be good for you. Our bodies cough to clear out excess mucus and other irritants, Edelman says.
Of course, that knowledge is probably small comfort when you’re up in the middle of the night with a miserable, hacking cough that won't stop. A lot of us would really prefer a few teaspoons of cough syrup -- whether it will really help us or not.