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What Is The Best Medicine For Chesty Cough?

What Is The Best Medicine For Chesty Cough

Chesty cough, also known as a productive cough, is characterized by the overproduction of mucus. Chesty cough can commonly be a symptom of a common cold and other acute conditions such as bronchitis, or long-term disease, for example, Chronic Obstructive Pulmonary Disease (COPD).

Mucus accompanying a chesty cough can be clear or colored (for example, yellow). Colored mucus may indicate a bacterial infection, especially when other symptoms are present, for example, high temperature. Patients commonly request over-the-counter medicines for a chesty cough.

In today’s post, I will seek to find the best medicine for chesty cough by looking at over-the-counter and pharmacy-only products available in the UK.

When To See A GP Regarding A Chesty Cough?

Patients Who Experience The Following Symptoms Should See A GP Regarding Their Cough:

Women coughing

  • Coughing up with blood (urgent appointment is recommended)
  • Chest pains
  • High temperature
  • Feeling very sick
  • Shortness of breath
  • Cough lasting longer than three weeks
  • Cough associated with an unexplained weight loss
  • Patient with a compromised immune system due to medicines taken or condition

Are Cough Syrups Effective In The Management Of Chesty Coughs?

The best evidence for or against the effectiveness of medicines comes from well-designed clinical trials. There is no good evidence for or against products (Cochrane, 2014)

What Active Ingredients Are Found In Medicines For Chesty Coughs?

A drug class used to manage chesty coughs is called expectorants. Guaifenesin is considered the main active ingredient found in chesty cough syrups. Guaifenesin is an effective and safe expectorant (Albrecht et al., 2017).
In the UK, guaifenesin is available in cough syrups and tablets in combination with other drugs.

How Does Guaifenesin Help With A Chesty Cough?

Guaifenesin increases the volume of secretions in bronchi (airways that lead into the lungs), which in turn decrease mucus ‘thickness.’ This process promotes a more effective removal of the phlegm.

Guaifenesin may also act directly on the epithelial cells in the airways to suppress mucus production (ibid). Guaifenesin can be considered the best medicine for a chesty cough.

Quick FAQ

Does Benylin Chesty cough (non drowsy) contain paracetamol?
No. Paracetamol is used in Benylin Cold & Flu Max Strength Tablets. Benylin Cold & Flu Day & Night Tablets. Benylin 4 Flu Tablets.

Use Of Sedative Antihistamines In Chesty Cough Medicines

Many coughs, colds, and flu medicines use sedative antihistamines as one of the main ingredients in their formulation. Diphenhydramine is a first-generation antihistamine used in the symptomatic treatment of allergies but more commonly as over-the-counter temporary sleeping aid medicines.

How Does Diphenhydramine Help With A Chesty Cough?

The use of diphenhydramine as an active ingredient in chesty cough syrups comes from the proposed mechanism of action of this drug, characterized by the following properties:

  • antitussive: prevent the cough
  • Anticholinergic: a range of effects on the body, including the proposed beneficial effect of reduction in mucus production.

Much less evidence supports the beneficial use of diphenhydramine in the management of chesty coughs. As compared to guaifenesin, diphenhydramine has the potential for more side effects, of which sedation and drowsiness are most prominent.

There is an inconsistency between the use of diphenhydramine as chesty cough medication and evidence supporting the effectiveness of this drug (Morice & Kardos, 2016).

What About Dry Coughs?

Dry coughs are usually managed with cough suppressants (pholcodine, dextromethorphan, simple linctus), which should not be used to treat chesty coughs. Cough suppressants can cause mucus retention, which may be harmful to some, for example, patients with COPD (NICE, 2020).

The Best Medicine For A Chesty Cough

Customers who have symptoms of a chesty cough have plenty of over-the-counter choices. Different brands of cough syrups contain very often the same active ingredients. Products containing just guaifenesin are available for self-selection in supermarkets, pharmacies, and online.

Combination products containing decongestants (pseudoephedrine) or a sedative antihistamine (diphenhydramine) are pharmacy-only medicines (P). P medicines can only be purchased from the pharmacy counter or registered online chemists.

Non-drowsy Chesty Cough Syrups

1. Robitussin Chesty Cough Medicine

Robitussin Chesty Cough Syrup contains guaifenesin, which from the context of this post, is one of the favorable ingredients to manage productive coughs. Robitussin Chesty Cough Syrup is available online and most pharmacies and supermarkets.

Larger bottles may be kept behind the pharmacy counter, although it is not a legal requirement.
Robitussin Chesty Cough Syrup key selling points:

  • Adults and children can use it over 12 years of age.
  • Non-drowsy
  • Sugar-free preparation
  • It contains only guaifenesin and effective expectorant, which loosens the mucus
  • Does not interact with any other medicines

Quick FAQ

How long does it take for Robitussin to work?
It works within 15 to 30 minutes of taking it. The medication's full effects appear approximately 2 hours after you take it.

 2. Supermarket Branded Guaifenesin Chesty Cough Syrups

Tesco's guaifenesin medicine for chesty cough

Tesco and other supermarkets sell their own-branded guaifenesin syrups which are priced very competitively.

For example, Tesco Health+ Chesty Cough Relief 300ml bottle sells just £2.25 (price taken 11/2020).

Tesco’s Chesty Cough Syrup – priced very competitively at £2.25 Guaifenesin syrup is available under different brands. Another popular brand of guaifenesin syrup is Benelin

3. Benylin Chesty Coughs (Non-Drowsy)

Benylin Chesty Coughs (Non-Drowsy) syrup contains a combination of guaifenesin and levomenthol. It is also known as Benylin Mucus Cough. Benylin Chesty Coughs contains the same amount of guaifenesin as a previously discussed Robitussin Chesty Cough Syrup.

Levomenthol is usually added to cough syrups and cold and flu products to improve breathing.

The mechanism of action by which (Levo)menthol helps to alleviate respiratory discomfort is found in some studies. Levomenthol acts on cold receptors present in the upper airways and nasal passages.

The cooling sensation produced by levomenthol reduces respiratory effort (Nishino et al., 2017). It also changes the perception of breathlessness by proposed actions in the central nervous system (Schwartzstein et al., 1987).

A combination of levomenthol and guaifenesin in one product is an attractive medicine for chesty coughs.

4. Benylin Chesty Cough And Cold tablet

I will now discuss products that may fit in the category of ‘the best’ cough medicines. One of the ingredients is (phenylephrine); however, its effectiveness is controversial.

Benylin Chesty Cough & Cold tablets offer an interesting combination of three active ingredients: guaifenesin to help with symptoms of productive cough.

Main active ingredients include:

  • Paracetamol (painkiller)
  • Guaifenesin (expectorant)
  • Phenylephrine Hydrochloride (decongestant)

Adults and children can use Benylin Chesty Cough & Cold tablet over 12 years of age. However, it seems like all active ingredients in the product aim to help with symptoms of ‘colds’ the there is a couple of disappointing properties behind this product. Firstly Benylin Chesty Cough & Cold tablets contain 250mg of paracetamol per pill.

With the recommended dose of two tablets taken every four hours as required, the maximum recommended dose for paracetamol for an adult is not met. Adults can take 1000mg of paracetamol every four to six hours (maximum 4g per day).

Secondly, the effectiveness of phenylephedrine as a decongestant, to relieve symptoms of congestion, has been questioned with some studies confirming that this drug is of similar efficacy to a dummy pill (a pill with no active ingredients taken during a clinical study).

Although Benylin Chesty Cough & Cold may seem like the right product for managing cold symptoms including chesty coughs, overall there are other options with active ingredients, which demonstrated better effectiveness (read reviews of medicines in the next two paragraphs).

5. Robitussin Mucus Cough And Congestion Relief

Robitussin Mucus Cough and Congestion is a pharmacy-only medicine (P) for the treatment of chesty cough. P medicines can only be sold in pharmacies (including online chemists) and should not be available for self-selection by customers.

It is one of my favorite combination products for managing chesty cough and nasal congestion, purely based on the drugs it contains, rather than on the experience.

Robitussin Mucus Cough and Congestion Relief product contains two active ingredients:

  • Guaifenesin, 100mg per 5ml
  • Pseudoephedrine Hydrochloride, 30mg per 5ml

I already discussed why guaifenesin is one of the best medicines for a chesty cough. Pseudoephedrine (not to be confused with phenylephrine) is a decongestion. Pseudoephedrine is considered an effective nasal decongestant, more effective than phenylephedrine.
Adults and children can use Robitussin Mucus Cough and Congestion Relief over 12 years of age.

Some factors to consider before use:

  • Several patients should not take pseudoephedrine, particularly with the following conditions: thyrotoxicosis, ischaemic heart disease, glaucoma, diabetes, enlargement of the prostate or urinary retention, or patients who take (or stopped within lats 14 days) a specific class of antidepressants called monoamine oxidase inhibitor (MAOI)
  • The use of pseudoephedrine should be limited to seven days.
  • One of the listed side effects of pseudoephedrine is insomnia. Patients should avoid taking pseudoephedrine at night.
  • There is a legal limit on how much pseudoephedrine can be sold to one patient. Usually, one product containing pseudoephedrine can be sold to one patient (total legally allowed content of pseudoephedrine = 720mg pseudoephedrine)

6. Benylin Mucus Cough Plus Decongestant Syrup

Benylin Mucus Cough Plus Decongestant Syrup

Benylin Mucus Cough Plus Decongestant Syrup has the same active ingredients as Robitussin Mucus Cough and Congestion Relief.

It is also a pharmacy-only medication that adults and children can use over 12 years.

Drowsy Medicines For Chesty Cough

All drowsy medicines for managing dry cough contain sedative antihistamines, which are used in combination with other ingredients. Some patients may find sedation a beneficial side effect if sleeping is a problem during an episode of cold.

Other uses of older generation antihistamines (which make you drowsy/sleepy) are the management of allergies and temporary relief of sleeping problems. Drowsy medicines for cough are pharmacy-only products.

1. Benylin Mucus Cough Night

Benylin Mucus Cough Night (also known as Benylin Dual Action Night Cough & Congestion) is the most favorable option in the category of drowsy medicines for a chesty cough, simply because of its active ingredients.

Every 5 ml of this product contain:

  • Diphenhydramine hydrochloride (sedative antihistamine)
  • Guaifenesin 100 mg (expectorant to help break down the mucus)
  • Levomenthol 1.1 mg

Benylin Mucus Cough Night

I already reviewed the potential benefit of diphenhydramine and levomenthol in the treatment of chesty coughs. As discussed guaifenesin is probably the single best drug to manage productive coughs.

Overall Benylin offers a great combination of active ingredients for patients who seek to help with their sleep. This treatment option is for adults and children over 12 years of age.

Patients who take (or recently stopped) monoamine oxidase inhibitors (MAOIs) should not use Benylin Mucus Cough Night.

Patients who have underlying conditions (asthma, liver problems, narrow-angle glaucoma, prostatic hypertrophy) should speak to a doctor or pharmacist before using this product.

2. Cheap Alternative Syrups For Chesty Coughs

Some pharmacies and supermarkets may sell their own branded products containing the same active ingredients as branded medicines. Supermarkets’ products are usually significantly cheaper than branded products in this category. For example, Tesco’s Dual Action Chesty Cough Relief Oral Solution.

This product contains a combination of two ingredients:

  • Diphenhydramine
  • Ammonium chloride

Priced at £1.50 for a 200ml bottle (price taken 11/2020) makes it one of the cheapest options for symptomatic management of productive coughs. Additionally, this product is licensed for children from 6 years of age.

It is thought that ammonium chloride works as an expectorant that loosens the mucus. However, this drug’s exact mechanism of action is still disputable (Birring et al., 2017).

In addition, Tesco sells chesty cough medicine – Chesty Cough Relief syrup, available for self-selection in health and beauty aisles (Priced at £2.25/November 2020).

Herbal Syrups For A Cough

Herbal products are used on a traditional basis to manage different conditions, including productive coughs on a traditional basis. One well-known and the well-advertised product is Bronchostop.

Bronchostop contains a combination of:

  • Thyme herb (Thymus vulgaris L. and Thymus zygis L., herb)
  • Marshmallow root (Althaea Officinalis L.)

Bronchostop when advertised is sh can be used in both dry and chesty coughs. Although there is little evidence to support the effectiveness of any of the ingredients found in this product. The application of both herbs is based on their long-standing use.

Quick FAQ

Does Bronchostop clear mucus?
Pholtex Bronchostop works in all stages of a cold-related cough, allowing you to use one product to treat any cough, whether it's wet, chesty, dry, tickly, or mucusy.

Best Chesty Cough Medicines For Children

Treatment of coughs in babies in toddlers is minimal. All cough syrups which contain active drugs are licensed for children six years of age and above. Simple products including honey and lemon or glycerol, for example, can be used in toddlers and children below six years of age, but should not be used to treat a chesty cough.

As previously mentioned cough suppressants such as glycerol may cause mucus retention, making symptoms of chesty coughs worse.

Parents of children with chesty cough symptoms have mainly a couple of options to choose from. Benylin offers two different products with ingredients that have been already reviewed in this post. Both products are pharmacy-only medicines.

Benylin Children’s Chesty Coughs

Benylin Children’s Chesty Coughs

Benylin Children's Chesty Coughs can be given to children aged six and above.

Benylin Children's Chesty syrup contains guaifenesin. Each 5ml of syrup equals to 50mg of guaifenesin (half the amount of an adult dose).

Benylin Children’s Night Coughs

Benylin Childrens Night Coughs

Benylin Children's Night Coughs syrup is equivalent to Benylin adult's chesty cough medicine, which contains diphenhydramine hydrochloride and levomenthol. This combination of active ingredients was reviewed earlier in the post.

The most prominent feature of Benylin Children’s Night Coughs is sedation, which is caused by the addition of diphenhydramine in the formulation.

Can You Treat A Chesty Cough With Prescription-only Medicines?

Patients who have ongoing chesty cough symptoms may commonly be diagnosed with COPD. In many cases, COPD is a condition caused by smoking. Treatment of COPD involves using different inhalers and drugs that improve mucus clearance from the airways.

Carbocisteine capsules are the most popular drug prescribed alongside other drugs in managing conditions characterized by excessive mucus production, for example, COPD.

Use Of Antibiotics For A Chesty Cough

Viruses cause common cold and flu. Antibiotics help fight bacterial infections and will not be useful in treating colds and associated chesty coughs. Inappropriate and unnecessary use of antibiotics contributes to antibiotic resistance, which means this class of drugs is less effective in treating bacterial infections.

Conclusion

In summary … what is the best medicine for chesty cough?
Patients seeking over-the-counter medicines for chesty cough have plenty of options to choose from. Guaifenesin seems to be the drug of choice due to its effectiveness, good tolerance, and lack of interactions with other prescription drugs. Additionally, guaifenesin is widely available off the shelf from supermarkets, chemists, and online vendors.

Patients who wish to treat their ‘cold and flu symptoms and associated cough can choose a combination of products from a pharmacy counter rather than products available for self-selection in supermarkets or pharmacies. There is not much evidence to support the use of phenylephedrine in managing congestion.

Pseudoephedrine (pharmacy-only medicine) is a better choice unless unsuitable due to underlying conditions or ongoing treatment with other drugs. A combination of guaifenesin and pseudoephedrine has a much more favorable place in managing coughs and congestion.

A sedative antihistamine may have some benefits in managing chesty coughs, although there is not much evidence to support this use. The drowsiness of sedative antihistamines may help with sleeping; however, this class of medicines does not necessarily elevate symptoms of chesty coughs.

References
  • Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidiscip Respir Med. 2017;12:31. Published 2017 Dec 11. doi:10.1186/s40248-017-0113-4 Available at https://dx.doi.org/10.1186%2Fs40248-017-0113-4 Accessed on 03/11/2020
  • Birring SS, Brew J, Kilbourn A, Edwards V, Wilson R, Morice AH. Rococo study: a real-world evaluation of an over-the-counter medicine in acute cough (a multicentre, randomised, controlled study). BMJ Open. 2017;7(1):e014112. Published 2017 Jan 16. doi:10.1136/bmjopen-2016-014112 Available at https://dx.doi.org/10.1136%2Fbmjopen-2016-014112 Accessed on 05/11/2020
  • Smith, S.M., Schroeder, K. and Fahey, T., 2014. Over‐the‐counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database of Systematic Reviews, (11). Available at: https://doi.org/10.1002/14651858.CD001831.pub5 Accessed on 02/11/2020
  • Morice A, Kardos P. Comprehensive evidence-based review on European antitussives. BMJ Open Respir Res. 2016;3(1):e000137. Published 2016 Aug 5. doi:10.1136/bmjresp-2016-000137 Available at https://dx.doi.org/10.1136%2Fbmjresp-2016-000137 Accessed on 03/11/2020
  • Nishino T, Tagaito Y, Sakurai Y. (1997). Nasal inhalation of l-menthol reduces respiratory discomfort associated with loaded breathing. Available at https://www.atsjournals.org/doi/full/10.1164/ajrccm.156.1.9609059 Accessed on 06/04/19#
  • Schwartzstein R. M., Lahive K., Pope A., Weinberger S. E., Weiss J. W. (1987) Cold facial stimulation reduces breathlessness induced in normal subjects. Available at: https://www.atsjournals.org/doi/abs/10.1164/ajrccm/136.1.58 Accessed on 06/04/19