More than 200 recommendations for preventing, diagnosing, and treating coughs in adults and children have been issued by the American College of Chest Physicians. One of the strongest is an evidence-based recommendation warning against giving children ages 14 and under nonprescription cough suppressants or expectorants; these remedies are ineffective and may be dangerous or even fatal to young children. Because of a lack of research evidence in other areas, however, many recommendations are based on expert opinion. Here are some highlights from the new guidelines, which were last updated in 1998.
* Adults up to age 65 should receive the new adult vaccine to prevent pertussis (whooping cough). An estimated 28% of new pertussis patients are adults who are no longer protected by the older pertussis vaccine they may have received as children.
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* Adults with acute cough from the common cold can be treated with an older type (sedating) antihistamine and decongestant-specifically, a brompheniramine/pseudoephedrine combination, possibly along with naproxen. No evidence supports the use of newer, nonsedating antihistamine preparations for cough control.
* Mucus-thinning products aren't effective in controlling cough in people with chronic bronchitis or neuromuscular impairment.
* Albuterol isn't recommended for controlling cough in patients who don't have asthma.
* Patients with a chronic unexplained cough should be evaluated for asthma.
Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines, Chest, RS Irwin, et al., January 2006.