Dry cough
Cough without sputum in acute viral respiratory infections, bronchial hyperreactivity, postnasal drip, GERD, or drug-induced (ACE inhibitors – 5–20%). ACCP 2018 and NICE NG120 (2019) base acute cough management (under 3 weeks) on observation, hydration, and lozenges as needed. Cough suppressants (dextromethorphan, codeine) are used in limited fashion for severe non-productive cough disturbing sleep. Cough lasting over 8 weeks needs evaluation for asthma, GERD, postnasal drip, eosinophilic bronchitis.
ICD-10 R052 drugs
Also known as: Non-productive cough, Unproductive cough
Drugs used for this condition
- CCloperastineAdd-on therapy · Cough suppressant with central and peripheral actionCloperastine is the most popular dry cough remedy in Spain: Flutox, Sekisan and Cinfatusina sit in every pharmacy. The AEMPS ficha técnica frames the indication as treatment of unproductive forms of cough – irritative and nervous – in adults and children from 2 years, 10 ml three times a day for adults. The evidence base for cough suppressants as a class is weak: the 2014 Cochrane review of over-the-counter cough medicines found no convincing data in their favor, and there are no separate large trials of cloperastine. So the sensible frame is this: a few days for an exhausting dry cough that prevents sleep, and stopping as soon as the cough turns productive. The ficha asks for reassessment if cough lasts beyond a week and reminds about drowsiness at the wheel.
- CDextromethorphanSecond line · Centrally acting cough suppressantUsed in dry non-productive cough disturbing sleep or daily activity. ACCP 2018 and NICE NG120 (2019) do not list central cough suppressants as first-line – modest efficacy data in acute cough (2014 Cochrane meta-analysis showed no significant advantage over placebo in adults). Adult dose 15–30 mg 3–4 times daily. Short course, no more than 7 days.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit