About a week ago, I had a problem. My wife and I were getting ready to leave on a week-long ski trip to Colorado, and I had a cough. Not one of those light coughs, the kind of cough that becomes that is more of a career than a distraction, the one where you cough for 15 minutes straight.
It was, not surprisingly, making it hard for me to sleep. One night, while sitting up on the couch in the basement, waiting for it to stop, I decided to do a little bit of research. Just like anybody would do, I pulled out my laptop, fired up Chrome, and did a search for methods of cough treatment.
Okay, that’s not true; first I searched for cough and came up with an impressive list of deadly diseases that I had a minute chance of having. Then I did a search for cough treatments, and, after a bit of digging, ran across the following paper.
Diagnosis and Management of Cough
Executive Summary
ACCP Evidence-Based Clinical Practice Guidelines
The ACCP is, of course, the American College of Chest Physicians. Amazingly, the paper is free (most journal articles are not), so I pulled it up and started reading. It’s heavy going if you are a medical amateur, but basically, they did a huge study of the available evidence relating to cough and came up with expert recommendations. After a bit of reading, I came to the section on the common cold (section 11 if you want the details). It has two interesting findings:
- Patients with acute cough (as well and PND and throat clearing) associated with the common cold can be treated with a first-generation A/D preparation (brompheniramine and sustained-release pseudoephedrine). Naproxen can also be administered to help decrease cough in this setting. Level of evidence, fair; benefit, substantial; grade of recommendation, A
- In patients with the common cold, newer generation antihistamines are ineffective for reducing cough and should not be used. Level of evidence, fair; benefit, none; grade of recommendation, D
Pseudoephedrine was most commonly available as Sudafed, which was great stuff until it started getting used for meth production and got moved behind the counter (at least in Washington; in some states it’s by prescription only). Naproxen is available over the counter as Aleve. Note that dextromethorphan, the most common cough-suppressant in OTC cough medicines, is not recommended in this situation (it does show up elsewhere, as does codeine).
So, on the way to the airport, we hit a pharmacy, and I picked up some 12-hour Sudafed and Aleve, and, when we got to our first night, took both.
It made a huge difference; I had no big cough attacks that night. I did note, however, that the aleve made me feel spacey and I didn’t sleep well, so I dropped that in later nights.
Note that Sudafed makes an OTC series called “Sudafed PE”, where the PE stands for “Phenylephrine”, not “Pseudoephedrine”. You want the real stuff.
