Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Nothing works for cough associated with the common cold
Clinical Question
Which treatments are safe and effective for cough associated with the common cold?
Bottom line
Suck it up: you have a cold, it'll get better. That seems to be the bottom line from this expert panel report, which found little evidence of benefit for most commonly used medications for the self-limited condition of the common cold. Ultimately, physicians must often act in the absence of good evidence, and it is reasonable to recommend safe options for the treatment of cough even if the optimal evidence is not available. These treatments include honey, dextromethorphan, and possibly zinc for patients with cough. 1a-
Reference
Study design: Systematic review
Funding: Other
Setting: Other
Synopsis
Although billed as an "expert panel report," this was really a hybrid of a systematic review, an "umbrella review" of published systematic reviews, and a guideline. The authors did a careful literature search, identifying randomized controlled trials (RCTs), as well as previous systematic reviews, and updated the searches of the published systematic reviews. They included any randomized trial of any treatment for acute cough in patients with an upper respiratory tract infection or the common cold. Although the authors said they looked for studies of herbal supplements, and included a few of them, the Cochrane Review of pelargonium sidioides was not included.The studies were assessed for quality using the Cochrane Risk of Bias tool for RCTs and a similar tool for systematic reviews, and excluded any studies at high risk of bias. The expert panel reviewed the evidence, then made 4 key recommendations. They concluded that there was insufficient evidence to make a recommendation for acetylcysteine or carbocysteine, and they recommend against the use of over-the-counter cold medications available in the United States to treat cough. They also recommend against the use of nonsteroidal anti-inflammatory drugs, given their lack of proven efficacy and, of course, their potential harms. Honey gets some love: The authors conclude that for children older than 1 year and adolescents with cough, honey is probably better than placebo or diphenhydramine, but not any better than dextromethorphan (…which they just told us not to use). Zinc had mixed evidence, and some of the benefit was attributed to underlying zinc deficiency in some countries, as well as the difficulty in masking patients to the treatment. In the end, the panel did not recommend the use of zinc. They also found no good evidence supporting or refuting the benefits of over-the-counter antitussives, expectorants, mucolytics, antihistamines, or combinations of any of them. Finally, the panel recommends against using codeine-containing medications in children.
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA
Comments
Why would you suppress most coughs - which are functional?
My owen treatment for common cold at acute face is applying surgical mass and 375 mg 3-4 time / day , vicks inhaler also has been helpful I am neurosurgeon has no knowledge of common cold or it,s treatment , I did use double mask during surgery and noticed the difference and continued to use it also wet environment for example breading from periphery of boiling water help, now I am 75 yrs old but always prone to common cold cough and congestion with theses treatment control has been effective and easy for me and I didn't have to take any days off 15-20 yrs ago I had my question from patients and colleague , but looks like every knows about befinte mask, which not only prevent spread make your upper respiratory tract comfortable.
Again inmy personal exprince antihystaminic make secretion thicker ? if this could cause pnemonia.
We start with that there is no virology To establish that there is in fact a cold.
Then we don’t placebo controlled for anything? This is junk.
It would be a joy if the public would truly embrace the idea that you can actually get better from a cold by just putting up with it - especially the post-viral cough that had me hacking away for 5 weeks this winter. (I slept at on the couch for a few nights at its height to maintain matrimonial bliss.) How did I treat myself - buckwheat honey, fresh lemon juice, and herbal tea. Don't know if it made my cough go away sooner but the self-indulgent pampering sure made me feel better within myself. Now I have the whole office on board. Will have to expand my recommendation to appropriate patients next season - and hopefully convince them not to come and see me next time!
They did not comment on using Hydrasense to reduce nasal congestion
Please don't ever tell your patients that there is nothing you can do for them and to "suck it up". You can't do much for any of the things we see but we can always comfort the patient. Don't forget about the magic you have.
Again honey gets some vote- anyone knows why?
Good poem
I love that the author comes "this close" to saying, suck it up, Buttercup!