4 Managing cough

4 Managing cough

We will review and update these recommendations on a regular basis.

4.1 Be aware that older patients or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia. This could lead to respiratory failure and death.

4.2 If possible, encourage patients with cough to avoid lying on their back because this makes coughing ineffective.

4.3 Use simple measures first, including getting patients with cough to take honey (for patients aged over 1 year). See table 1 for treatments for managing cough.

4.4 For patients with COVID-19 consider short-term use of codeine linctus, codeine phosphate tablets or morphine sulfate oral solution to suppress coughing if it is distressing.

Table 1 Treatments for managing cough in adults aged 18 years and over

Treatment

Dosage

Initial management: use simple non-drug measures, for example taking honey

A teaspoon of honey

First choice, only if cough is distressing: codeine linctus (15 mg/5 ml) or codeine phosphate tablets (15 mg, 30 mg)

15 mg to 30 mg every 4 hours as required, up to 4 doses in 24 hours

If necessary, increase dose to a maximum of 30 mg to 60 mg 4 times a day (maximum 240 mg in 24 hours)

Second choice, only if cough is distressing: morphine sulfate oral solution (10 mg/5 ml)

2.5 mg to 5 mg when required every 4 hours

Increase up to 5 mg to 10 mg every 4 hours as required

If the patient is already taking regular morphine increase the regular dose by a third

Special considerations

Seek specialist advice for patients under 18 years old

Consider addiction potential of codeine linctus, codeine phosphate and morphine sulfate. Issue as an 'acute' prescription with a limited supply. Advise the patient of the risks of constipation and consider prescribing a regular stimulant laxative

Avoid cough suppressants in chronic bronchitis and bronchiectasis because they can cause sputum retention

Notes: See BNF and MHRA advice for appropriate use and dosing in specific populations.

All doses are for oral administration.