Productive cough
Cough producing sputum – a protective reflex in respiratory infections, COPD, bronchiectasis, and cystic fibrosis. NICE NG120 (2019) and ACCP 2018 set watchful waiting and adequate hydration as base management for acute cough under 3 weeks, since 90% are viral and self-limiting. Mucolytics (bromhexine, ambroxol, carbocisteine) showed modest or no benefit in Cochrane 2019 for acute bronchitis; routine prescribing in otherwise healthy adults is not recommended. In COPD with chronic bronchitis, mucolytics (carbocisteine, N-acetylcysteine) modestly reduce exacerbation frequency per GOLD 2024.
ICD-10 R057 drugs
Also known as: Wet cough, Chesty cough
Drugs used for this condition
- CAcetylcysteineCase-by-case decision · Mucolytic; paracetamol overdose antidote; glutathione precursorMucolytic for productive cough with thick sputum. AEMPS keeps acetylcysteine indicated, but the clinical effect is modest: systematic reviews show cough duration reduced by about 0.5 days vs placebo. In cystic fibrosis, Cochrane 2013 did not confirm benefit from oral NAC. In common colds a 5–10 day course is appropriate. If cough persists beyond 7–10 days or dyspnoea appears, in-person evaluation is required.
- CAmbroxolAdd-on therapy · Mucolytic agentUsed symptomatically for cough with hard-to-clear sputum. Adult dose 30 mg three times daily or extended-release 75 mg once daily. The Cochrane acute-cough review (Smith 2014) showed a modest effect on cough duration and intensity with low certainty. In chronic bronchitis and COPD, long-term ambroxol or N-acetylcysteine modestly reduces exacerbation frequency (Cochrane 2019 mucolytics review in chronic bronchitis and COPD; mucolytics are also noted in GOLD).
- CBromhexineAdd-on therapy · Mucolytic agentUsed symptomatically for cough with hard-to-clear sputum as part of combined therapy in acute bronchitis and chronic lung disease. Adult dose 8–16 mg three times daily. Cochrane 2019 meta-analysis of mucolytics in acute bronchitis showed modest effect on cough duration (mean 1–2 days shorter) with low certainty. ACCP 2018 does not recommend mucolytics in acute bronchitis in otherwise healthy adults.
- CCarbocisteineAdd-on therapy · Mucolytic agentUsed in cough with hard-to-clear sputum in acute bronchitis, chronic obstructive lung disease, and bronchiectasis. Adult dose 750 mg three times daily. In COPD, long-term use (over 6 months) modestly reduces exacerbation frequency per the Cochrane 2019 meta-analysis (RR 0.75, 95% CI 0.68–0.84). In acute bronchitis in otherwise healthy adults, effect is modest – not a preferred choice in international guidelines.
- CGuaifenesinAdd-on therapy · ExpectorantGuaifenesin is an over-the-counter expectorant. The AEMPS Frispec label words the indication carefully: the product helps reduce phlegm and bronchial secretions in productive forms of cough in adults and children over 2. The Cochrane review of over-the-counter medicines for acute cough (2014) found mixed results for guaifenesin: in some trials expectoration came easier, in others there was no difference from placebo. So this is a supportive measure rather than treatment: fluids and humidified air help, and the illness still resolves on its own schedule. The label forbids two things: using the product for chronic or persistent cough, asthmatic cough included, and combining it with cough suppressants – one thins the sputum, the other blocks bringing it up. A cough lasting beyond three weeks is investigated rather than syruped.
- CIvy leaf dry extract (Hedera helix)Add-on therapy · Herbal expectorantIvy syrup is the best-selling herbal cough product in Spain: Prospantus, Cinfahelix, Hedetus. The 2018 EMA HMPC monograph recognizes well-established use of ivy leaf as an expectorant for productive cough in adults, adolescents and children from 2 years, and the AEMPS ficha técnica repeats the same wording. The quality of the evidence is worth knowing in advance: the updated systematic review by Sierocinski and colleagues (Eur J Clin Pharmacol 2021) found only a handful of randomized trials, most of them small and at high risk of bias, with a modest effect compared with placebo. So the product is well tolerated and written into European practice, yet a rapid end to coughing is not what it delivers. The ficha asks people to see a doctor with breathlessness, fever or purulent sputum.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
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