Pharmacology and Therapeutics of Cough -  edited by K. Fan Chung, John Widdicombe
Of the estimated 963.6 million visits made to physicians offices in the USA, cough is the most common symptom for which individuals seek medical attention and spend health care dollars.  In the USA, the cough/cold market represents several billion dollars worth of sales for over the counter products alone, not including the cost of prescription drugs………… In a survey of 7,251 households with at least one child aged 1-5 years, 85% of the physician visits were for asthma like symptoms including cough, with 35% of children making three of more visits during a 6 month period.  Over half of the children received cough treatment.

An expectorant increases bronchial secretions and mucolytics help loosen thick bronchial secretions. Expectorants reduce the thickness or viscosity of bronchial secretions thus increasing mucus flow that can be removed more easily through coughing. Mucolytics break down the chemical structure of mucus molecules. The mucus becomes thinner and can be removed more easily through coughing.[Adams, Holland, & Bostwick, 2008] 

Medsurg Nurs. 2014 Nov-Dec;23(6):391-6.  Recognizing Signs of Prescription Drug Abuse and Addiction, Part I.  Felicilda-Reynaldo FD.
Prescription drug abuse/misuse is increasing. Nonmedical use of prescription medications, especially opioid analgesics, now is considered an epidemic in the United States. Medical-surgical nurses are in a strategic position to help address substance abuse problems in patients.  PMID:  26281634

OBJECTIVE: To provide an overview of drug use in outpatient children in France, a population-based study using a national reimbursement claims database representative of 90% of the French population………
RESULTS:   In 2011, 133 800 children were included in the study. The overall prevalence of drug use was 84% and the median number of different drugs per child was 5. Drug use was greatest in children aged <2 years. The most widely used drugs were paracetamol, systemic anti-infectives, nasal corticosteroids and decongestants, and anti-histamines. 21% children <2 years received domperidone.  
CONCLUSIONS:   There is widespread use of medicines that are unlikely to be effective and may have significant toxicity in French children. Irrational use of medicines appears to be greatest in children aged 5 years and under.  PMID:  25977563

A 36-year-old man presented to the emergency department acutely unwell after being found collapsed while running a half marathon. He presented with a reduced Glasgow coma score, was tachycardic, agitated, hypoxic and profusely sweating. He had taken a 'supplement' given to him prior to the race by a friend, as he was concerned about not finishing. This contained both caffeine and a large dose of ephedrine (60 mg in total). After initial resuscitation he was intubated, and was transferred to critical care. He subsequently developed rhabdomyolysis, requiring haemofiltration.  PMID:  22669965

In 2010, the American College of Medical Toxicology (ACMT) established its Case Registry, the Toxicology Investigators Consortium (ToxIC). All cases are entered prospectively and include only suspected and confirmed toxic exposures cared for at the bedside by board-certified or board-eligible medical toxicologists at its participating sites. The primary aims of establishing this Registry include the development of a realtime toxico-surveillance system in order to identify and describe current or evolving trends in poisoning and to develop a research tool in toxicology. ToxIC allows for extraction of data from medical records from multiple sites across a national and international network.

All cases seen by medical toxicologists at participating institutions were entered into the database. Information characterizing patients entered in 2012 was tabulated and data from the previous years including 2010 and 2011 were included so that cumulative numbers and trends could be described as well. The current report includes data through December 31st, 2012. During 2012, 38 sites with 68 specific institutions contributed a total of 7,269 cases to the Registry. The total number of cases entered into the Registry at the end of 2012 was 17,681.

Emergency departments remained the most common source of consultation in 2012, accounting for 61 % of cases. The most common reason for consultation was for pharmaceutical overdose, which occurred in 52 % of patients including intentional (41 %) and unintentional (11 %) exposures. The most common classes of agents were

• sedative-hypnotics (1,422 entries in 13 % of cases)
• non-opioid analgesics (1,295 entries in 12 % of cases),
• opioids (1,086 entries in 10 % of cases) and
• antidepressants (1,039 entries in 10 % of cases).

There were 57 deaths reported in the Registry in 2012. The most common associated agent alone or in combination was the non-opioid analgesic acetaminophen, [paracetamol] being reported in 10 different cases.

Other common agents and agent classes involved in death cases included

• Ethanol [alcohol],
• Opioids
• the anti-diabetic agent metformin,
• sedatives-hypnotics and
• cardiovascular agents, in particular amlodipine.

There were significant trends identified during 2012. Abuse of over-the-counter medications such as dextromethorphan remains prevalent. Cases involving dextromethorphan continued to be reported at frequencies higher than other commonly abused drugs including many stimulants, phencyclidine, synthetic cannabinoids and designer amphetamines such as bath salts. PMID:  24178902

 

Evid Based Med. 2015 Jun;20(3):98. doi: 10.1136/ebmed-2014-110156. Epub 2015 Mar 5. 
There is no good evidence for the effectiveness of commonly used over-the-counter medicine to alleviate acute cough. 
De Sutter A - Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.  PMID:  25743170

Cochrane Database Syst Rev. 2014 Nov 24;11:CD001831. doi: 10.1002/14651858.CD001831.pub5. - Over-the-counter (OTC) medications for acute cough in children and adults in community settings - Smith SM, Schroeder K, Fahey T.   1HRB Centre for Primary Care Research, Department of General Practice, RCSI Medical School, 123 St Stephens Green, Dublin 2, Ireland.

Acute cough due to upper respiratory tract infection (URTI) is a common symptom. Non-prescription, over-the-counter (OTC) medicines are frequently recommended as a first-line treatment, but there is little evidence as to whether these drugs are effective…..
We included 29 trials (19 in adults, 10 in children) involving 4835 people (3799 adults and 1036 children). All studies were placebo-controlled RCTs. However, assessment of the risk of bias of the included studies was limited by poor reporting, particularly for the earlier studies….. antitussives (data from three studies), antihistamines (data from three studies), antihistamine-decongestants (two studies) and antitussive/bronchodilator combinations (one study) were no more effective than placebo. ……. One new trial indicated that three types of honey were more effective than placebo over a three-day period.  Twenty-one studies reported adverse effects. There was a wide range across studies, with higher numbers of adverse effects in participants taking preparations containing antihistamines and dextromethorphan.  PMID:  25420096

Over-the-counter cough and cold medications are not effective in treating children with the common cold and might cause serious side effects, including death. New recommendations restricting use in Canada to those older than 6 years of age are effective immediately, with relabeling of products starting in the fall of 2009.  PMID:  19910592

This paper provides an overview of our current understanding of the serotonergic and opioidergic mechanisms of cough and antitussives. …… it is possible to speculate that 5-HT1 receptors, in particular the 5-HT1A receptors, may be more important than others with respect to the effect of antitussive drugs….. the results indicate that the antitussive effects of opioids are mediated predominantly by mu- and kappa-opioid receptors [and] that mu 2- rather than mu 1-opioid receptors are involved in mu-opioid receptor-induced antitussive affects. [also] the results suggest that sigma sites may be involved in the antitussive mechanism of non-narcotic antitussive drugs.  PMID:  9232674

In June 2016, eHealthme ceased to provide the information on which all the data in this section is based.  On querying my friends in the USA, it would seem that many of the sites that provided similar information, have done the same.  The links we provided to eHealthme also no longer work as this data too has been removed. 

As to why all these sites have removed exceptionally important information, my USA helpers said that more and more people are questioning what they are being given – and demanding to know WHY the CAUSE of their illness has not been investigated.  It appears that there has been a very heartening increase in the numbers of people who want to be healed – have the cause tackled and not the symptoms.  And this is ‘not popular’ with the conventional medical community, who cannot make money from well people.

The statistics collected from eHealthme remain valid for the date they were collected.  As such we have left this section as it is – an historical record.  Please read this section therefore only as an historical record of the figures that were applicable on the date specified.