Coughing plays a vital role in clearing out your respiratory pathway from foreign irritants. An occasional cough is normal. In fact, some coughing is necessary for us to be healthy. However, when your cough is persistent, you should start to consider cough treatments and remedies to manage it.

A chronic cough is one that lasts for more than eight weeks in adults and four weeks in children. There are many causes of a persistent cough. While most of us might associate cough with underlying infections, such as the flu, the most common causes of a chronic cough¹ are asthma, gastroesophageal reflux, post-nasal drip, or a combination of these. Coughs can also come in different varieties. Some coughs are dry, some have phlegm, and others might have a distinct sound (such as whooping cough).

To understand your cough better, first consider consulting with your healthcare provider. This is important because specific varieties of cough might require specific types of treatment. However, in most instances, these simple cough treatments and remedies can help stop coughing or at least reduce it.

Cough Treatments

Treatments for coughs come in different varieties such as syrup or tablets. It depends on what aspect of the cough is being focused on by the treatment – a wet cough from a post-nasal drip will require different treatment to a dry cough caused by allergies.

Certain varieties of cough require cough medications to manage them. Most of these have underlying causes as to why the cough has occurred in the first place. Regularly taking these medications helps to reduce cough frequency over time. However, for some cough might reduce, but not go away completely, which would require sourcing other ways to manage a chronic cough.

When considering cough medications for children, there are options of over-the-counter medications which may work to treat the cough. However, it would be ideal to get a prescription for all cough medications as dosing and side effect profiles vary for children

This is because getting a prescription requires visiting a medical practitioner, who will assess your child and assign the most appropriate medication and discuss dosage amounts. Several treatments for cough contain ingredients that, when given to children in an adult dose, can have life-threatening side effects, such as slowing down the breathing rate. 

The FDA suggests² avoiding OTC cough medications for children younger than 2 years of age.

OTC Cough Treatments

When we start coughing, one of the first treatments that we generally resort to is over-the-counter cough syrup. The two most common variants of cough syrups are expectorants and cough suppressants.

An expectorant loosens any mucus present within your respiratory tract and facilitates the cough reflex to get rid of it and any trapped irritants. You will often notice yourself coughing more when you take an expectorant. Ridding yourself of the irritant trapped in your lungs will help address the source of a productive cough. Guaifenesin³ is the most common ingredient found in OTC expectorants.

A cough suppressant (antitussive) works to decrease your cough frequency. It is usually taken when you have a persistent dry cough without much phlegm production, where coughing is only doing harm by irritating your throat and not bringing up any irritants from the lungs. Dextromethorphan⁴ is the most common antitussive available over the counter.

Most of the available cough syrups take a day or two to work in reducing your cough frequency.

Medications to Treat the Underlying Cause

Some coughs are a result of exposure to allergens or a by-product of underlying illness. 

When you experience an upper respiratory illness it is not uncommon to have a runny nose and respiratory discomfort for a few days before the cough appears. The increased mucus flow is a continuous trigger to the cough reflex that eventually results in a cough.

To manage this, treating the underlying cause is required (i.e., the original illness or allergic response). Minimizing the effect of allergens or slowing down mucus flow can help with reducing the cough. 

Antihistamines, such as cetirizine⁵ or fexofenadine (an ingredient found in Allegra⁶), are the most commonly used drugs to manage reactions, such as a cough, to allergens.

Decongestants, often with active ingredients such as phenylephrine⁷ or pseudoephedrine⁸, help to minimize mucus production in both respiratory infections (like colds) and allergic reactions. Reduction in mucus eliminates the trigger that is causing the cough.

Antibiotics

Antibiotics can help treat the underlying bacterial infection causing your cough. They require a prescription from your healthcare provider.

In addition to a cough, bacterial illnesses generally come with a high fever as well as difficulty breathing and chest discomfort. Once the underlying illness is treated, the cough generally resolves on its own with time.

Not all upper respiratory illnesses can be managed with antibiotics. Only ones with a bacterial origin, such as pneumonia or tuberculosis, require antibiotics as a treatment for cough. Viral illnesses, such as the common cold, influenza (flu), or COVID-19, cannot be treated by antibiotics.

People with long-term conditions such as chronic bronchitis or emphysema might experience recurrent infections that often present with a cough. These respiratory conditions may have frequent requirements for antibiotics, which needs to be discussed with your primary care practitioner. 

You must take the entire course of medication, even if you start to feel better. Not only can stopping before finishing the whole course mean that the infection can still be inside your body and flare up again, causing more coughing and illness, but the remaining bacteria will be those most resistant to the antibiotics. If these bacteria are allowed to grow in number, an antibiotic-resistant strain of the infection could develop and spread, which would be much harder to treat. 

Beware: Antibiotic resistance

Antibiotic resistance is currently a global crisis.⁹ With incomplete dosing schedules to overuse of antibiotics, there is a looming risk that standard antibiotics will no longer work on infectious bacteria. Many health conditions, such as tuberculosis¹⁰ (an infection that results in a cough), struggle with treatment regimes due to multidrug resistance. This means completing your antibiotic dosing schedule, and opting out of self-medicating with antibiotics can help lower the risk of developing resistant strains of infections that cause chronic coughs.

Pain Management

A cough can cause significant discomfort, especially the forceful action of coughing itself. 

It is possible to experience pain and muscle soreness in the chest or back from the effort exerted to expel air from the lungs. Pain can also be the result of underlying illness. 

This is often why painkillers are often prescribed with cough medicines. Over-the-counter paracetamol (Tylenol),¹¹ which also manages fever, works as a pain reliever in most instances. However, in some instances, stronger painkillers might be prescribed.

Cough Remedies

Sometimes, medication is unavailable or unnecessary and the best way to tackle your coughing is with home remedies. These are relatively easy to find around the house and many times work wonders toward easing a cough. Coupling home cough remedies with prescription medication is often the best way to manage a nagging cough.

Remaining Hydrated

One of the key aspects of managing a cough is proper hydration – which means continuously consuming fluids. 

A frequent piece of advice when you are down with the flu is bed rest with drinking plenty of water. This is because fluids help to naturally soothe a dry throat, which often contributes to a persistent cough. Additionally, fluids help to reduce the viscosity of mucus build-up in your respiratory pathways, clearing out your nasal passages. Finally, proper hydration is a key part of being healthy and contributes to the proper working of your body – this is even more important to maintain than normal when you are ill, as your body is under a lot of strain.

Warm Beverages

Grandma’s advice to drink warm soup if you are sick holds some truth when it comes to home remedies for cough. Hot soup packed with ginger, lemon, and other feel-good ingredients can help to ease a sore throat, limiting a persistent cough. 

Warm beverages have also been subjectively noted to improve mucus flow¹² and clear blocked nasal passages. 

Honey

Honey may seem like quite an obvious go-to when you have a sore throat, and it should be – it has several antimicrobial¹³ and antioxidant¹⁴ properties, making it a great home remedy for cough.

In one study,¹⁵ honey was observed to be superior to dextromethorphan (e.g. DayQuil, Buckley's Mixture)¹⁶ in reducing children’s nocturnal cough and improving sleep.

Honey has also been hypothesized to assist with mucus clearance¹⁷ as well as desensitizing the cough reflex¹⁸

Honey should not be given to children younger than 12 months of age due to the risk of developing infant botulism.

Ginger

While ginger has been popularly known to tackle an upset stomach, it is also considered in several households to assist with a sore throat and nagging cough. Studies¹⁹ have indicated that components within ginger can help relax smooth muscles present in your airways. This is especially useful if your coughing is a result of airway constriction, as with asthma. 

Ginger also has anti-inflammatory properties,²⁰ which can aid in managing possible underlying inflammation that has resulted in your cough. 

Ginger can be eaten plain or mixed in herbal tea for soothing relief.

Herbal Supplements

Many herbs have been studied regarding their ability to ease inflammation and mediate flu symptoms. Some of the herbs you can experiment with as an aid with your cough are:

• Ivy leaf,²¹
• marshmallow root,²²
• slippery elm,²³
• peppermint,²⁴
• and thyme²⁵

Extracts from these herbs have been noted to have antioxidant properties and many of them also help ease mucus production. These herbs can be mixed in teas or other beverages, or taken as dietary supplements. Peppermint and slippery elm also come in lozenges. They work great as cough remedies as they require you to suck on them, thus lubricating your throat even more.

Menthol

Extracted from peppermint, menthol is generally found in vapor rubs and lozenges, and is frequently used when tackling the flu. Inhalation of menthol has been shown to reduce cough sensitivity.²⁶ It also soothes the throat following exposure to irritants, reducing the likelihood of coughing.

Humidifier

The primary purpose of adding a humidifier to your room is to moisten the air you are breathing in. Dry air can often worsen a cough. Cool-mist humidifiers are sufficient to assist with this. 

It is vital to clean out humidifiers and prevent mold and bacteria build-up, which could, in the long run, be causing more harm than any cough relief they provide.

You can combine the previous remedy – menthol – and increased humidity by adding a few drops of menthol oil to a bowl of freshly boiled water, draping a towel over your head, and leaning over the bowl to make your own menthol steam bath.

Rinsing Out Your Airways

While salt water gargles are often considered for a sore throat, they have plenty of benefits in managing a nagging cough as well. It helps to clear away irritants that might be lingering in your throat and any excess mucus that has built up. 

Similarly, using a neti pot to irrigate your nasal passages²⁷ can also soothe inflammatory passages, which could be a primary cause of your cough. Typically you should do this at least three to four times a day to observe any changes.

You must clean all nasal irrigation equipment after every use. Otherwise, bacteria may develop and you may be giving yourself an infection instead of helping to clear one. Microwaving and Milton’s sterilizing solution²⁸ are recommended methods.

Making Behavioral Changes

While there are many in-the-moment remedies for a cough that you can try within the comforts of your home, there are also some simple modifications to daily habits which you can make to reduce your likelihood of a persistent nagging cough.

Maintaining a Healthy Weight

Staying within your healthy weight reduces the likelihood of developing conditions such as gastroesophageal reflux (GERD),²⁹ which is a common cause³⁰ of a persistent cough. 

Exercising and eating healthily also improve your immune system. This will lower your risk of developing infections that could be causing a cough. 

Additionally, exercising helps to improve diaphragm and intercostal rib muscle strength, which are crucial respiratory muscles. Certain asanas of yoga have also shown benefits for those who have mild coughs.

Avoiding GERD Triggers

Gastroesophageal acid reflux (GERD) accounts for about 40% of chronic cough.³¹ Triggers for this type of cough are often difficult to tease out, primarily because coughs are not frequently attributed to underlying gastric complaints.

Being overweight and not following a healthy diet is one of the primary triggers for GERD. 

Additionally, spicy food, fried food, chocolate, citric foods,³² alcohol, peppermint, and caffeine³³ are known triggers of GERD. You should avoid heavy meals, especially before bedtime.

Quitting Smoking

Cigarette smoke, second-hand smoke, and/or constant exposure to pollutants can aggravate a cough. Smoking is also linked as a risk factor³⁴ for developing COPD (chronic obstructive pulmonary disease) and chronic bronchitis, frequent causes of long-term cough. Not to mention lung and other cancers.

As soon as you quit smoking your lungs begin to recover.³⁵ For many previous smokers, coughing usually reduces. Kicking the habit also has numerous other benefits, like improving your exercise tolerance and reducing your risk of developing heart disease and cancers.

Adopting Cough Suppression Techniques

Certain techniques have been studied³⁶ to assist with decreasing the frequency of nagging coughs. While the initial methods to manage a cough are often with medications, chronic and especially refractory coughs might require alternative methods of management. One such method is cough suppression therapy (CST).³⁷

Behavioral CST is a technique that you can learn with the help of a speech therapist. As part of this technique, you employ more mindful breathing practices every time you feel like you are going to cough. Focus is shifted away from the cough to more rapid breathing practices. Airflow sounds, swallowing, and even eating cough drops are other distractors that you can use to minimize coughing. 

Initial attempts at CST will be with your speech or pulmonary therapist. They will monitor the manner in which you are suppressing your cough. They will also expose you to potential cough stimuli and observe your ability to control your cough.

Conclusion

It is difficult to curb a cough without actually understanding what the underlying cause for it might be. 

While infection is the most common cause of a cough, only a few infections have specific therapies that work in reducing their symptoms, including the cough. Even viral and bacterial infections are primarily treated with rest, fluids, and supplementary medications like cough syrups. 

Luckily, simple treatments and home remedies often work well to soothe the effects of a persistent cough. They go well with any medication that the doctor prescribed to you to ease soreness and fatigue that can result from a lot of coughing. 

A cough that lasts for more than eight weeks in adults and four weeks in children is chronic. It may be a sign of something underlying such as GERD or asthma. However, there are several cases where a chronic cough has no known causes, which makes managing it even more difficult. Therefore, it is always important to consult with your healthcare provider for coughs that linger.

Tracking your cough is a great way to understand your cough and how it changes over time. Along with coughs, logging any symptoms coinciding with the cough can help narrow down a specific cause. Often coughs change with the time of the day, as well as the duration of illness. These patterns will help you manage your cough more effectively and take control over it.

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