Chesty cough, also known as a productive cough, is characterised by overproduction of mucus. Chesty cough can commonly be a symptom of a common cold, but also 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 coloured (for example, yellow). Coloured 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.
Summary of the post:
- Are cough syrups effective in the management of chesty coughs?
- Non-drowsy chesty cough syrups
- Drowsy chesty cough syrups
- Herbal product for chesty coughs
- Best chesty cough medicines for toddlers
- Can you treat a chesty cough with prescription-only medicines?
- Use of antibiotics for a chesty cough
When to see a GP regarding a chesty cough?
Patients who experience the following symptoms should see a GP regarding their cough:
- 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 as the main active ingredient found in chesty cough syrups. Guaifenesin is regarded as an effective and safe expectorant (Albrecht et al., 2017).
In the UK, guaifenesin is available in the form of 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 which lead into the lungs), which in turn decrease mucus ‘thickness’. This process promotes more effective removal of the phlegm. Guaifenesin may also act directly on the epithelial cells located in airways to suppress mucus production (ibid).
Guaifenesin can be considered as the best medicine for a chesty cough.
Use of sedative antihistamines in chesty cough medicines
Many cough and cold and flu medicines use sedative antihistamines as one of the main ingredients in their formulation. Diphenhydramine is commonly used in combination with other components. Diphenhydramine is a first-generation antihistamine, which is used to 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, characterised 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 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 suppressant (pholcodine, dextromethorphan, simple linctus), which should not be used to treat chesty coughs. Cough suppressant 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 favourable 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:
- can be used by adults and children over 12 years of age.
- Sugar-free preparation
- Contains only guaifenesin and effective expectorant, which loosens the mucus
- Does not interact with any other medicines
2. Supermarket branded guaifenesin chesty cough syrups
Tesco and other supermarkets sell own-branded guaifenesin syrups (the same amount of guaifenesin per 5ml as other branded products), which are priced very competitively. For example, Tesco Health+ Chesty Cough Relief 300ml bottle sells just £2.25 (price taken 11/2020).
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 also sold as Benylin Mucus Cough containing a combination of guaifenesin and levomenthol.
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 has been described in some studies. It has been suggested that levomenthol acts on cold receptors which are present in 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).
Combination of levomenthol and guaifenesin in one product is an attractive medicine for chesty coughs.
4. Benylin Chesty Cough & Cold tablet
I will no discuss product which may fit in the category of ‘the best’ cough medicines. One of the ingredients (phenylephrine) is commonly added to products available for patient’s self selection, however its effectiveness is controversial.
Benylin Chesty Cough & Cold tablets offer an interesting combination of three active ingredients, one of which is guaifenesin to help with symptoms of productive cough. Main active ingredients include:
- Paracetamol (painkiller)
- Guaifenesin (expectorant)
- Phenylephrine Hydrochloride (decongestant)
Benylin Chesty Cough & Cold tablet can be used by adults and children 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 to be 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 a right product for the management of 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).
- The tablets provide Clinically Proven Targeted Relief For Your Cough From Day 1 - Benylin Chesty Cough and Cold tablets provides relief by targeting your cough deep in your chest to relieve cold symptoms
- Loosens Phlegm From Your Chest - Benylin Chesty Cough and Cold tablets contain guaifenesin, an expectorant which helps to thin and offer mucus relief in the chest, making it easier to cough up
- Helps Your Airways And Helps Reduce Cough Intensity From Day 1 - Benylin Chesty Cough and cold tablets help to relieve symptoms of blocked and runny noses. It contains phenylephrine, a nasal decongestant which helps reduce swelling in the passages of the nose and so that you can breathe more easily
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.
This is one of my favourite combination product for the management of 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 classified as decongestion. Pseudoephedrine is considered as an effective nasal decongestant, more effective than phenylephedrine.
Robitussin Mucus Cough and Congestion Relief can be used by adults and children 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)
- 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 has the same as active ingredients as the above Robitussin Mucus Cough and Congestion Relief. It is also a pharmacy-only medication, which can be used by adults and children over 12 years of age.
Drowsy medicines for chesty cough
All drowsy medicines for the management of 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 favourable 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
I already reviewed the potential benefit of diphenhydramine and levomenthol in the treatment of chesty coughs. As discussed guaifenesin is probably a single best drug to manage productive coughs.
Overall Benylin offers a great combination of active ingredients for patients who also 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. Supermarket own 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:
- Ammonium chloride
Priced at £1.50 for a 200ml bottle (price taken 11/2020) make 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 though that ammonium chloride works as an expectorant which loosens the mucus; however, the exact mechanism of action of this drug is still disputable (Birring et al., 2017).
In addition, Tesco also 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 which are used in the management of different conditions including productive coughs are used on a traditional basis. One well-known and 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 is advertised as a product, which 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. Application of both herbs in is based on their long-standing use.
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 suppressant such as glycerol may cause mucus retention, which can make symptom of chesty coughs worse.
Parents of children with symptoms of a chesty cough have mainly a couple of options to choose from. Benylin offers two different products with ingredients which have been already reviewed in this post.
Both products are pharmacy-only medicines.
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 Children’s Night Coughs syrup is equivalent to Benylin adult’s chesty cough medicine, which contains diphenhydramine hydrochloride and levomenthol. This combination of active ingredient 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 symptoms of a chesty cough may commonly be diagnosed with COPD. In many cases, COPD is a condition caused by smoking. Treatment of COPDs involves the use of different inhalers and drugs which improve clearance of mucus from the airways.
Carbocisteine capsules is the most popular drug prescribed alongside other drugs in the management of conditions characterised by excessive production of mucus, for example, COPD.
Use of antibiotics for a chesty cough
Viruses cause common cold and flu. Antibiotics help to fight bacterial infections and will not be useful in the treatment of colds and associated chesty coughs. Inappropriate and unnecessary use of antibiotics contributes to antibiotics resistance, which means this class of drugs is less effective in the treatment of bacterial infections.
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, chemist and online vendors.
Patients who wish to treat their ‘cold and flu’ symptoms and associated cough can choose a combination of product from a pharmacy counter rather than products which are available for self-selection in supermarkets or pharmacies. There is not much evidence to support the use of phenylephedrine in management of congestion.
Pseudoephedrine (pharmacy-only medicine) is a better choice unless not sutiable due to underlying condition or ongoing treatment with other drugs. Combination of guaifenesin and pseudoephedrine has much more favourable place in the management of coughs and congestion.
A sedative antihistamine may have some benefits in the management of 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.
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
Cochrane (2014). Over‐the‐counter (OTC) medications for acute cough in children and adults in community settings. 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
NICE, (2020). Aromatic inhalations, cough preparations and systemic nasal decongestants. Available at: https://bnf.nice.org.uk/treatment-summary/aromatic-inhalations-cough-preparations-and-systemic-nasal-decongestants.html 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