Cough home remedies: which ones are worth your time

Almost every household has a remedy it trusts, usually inherited, usually administered with confidence. Some of them work. One has better evidence behind it than the syrup you would buy at a chemist. And two of the most popular are genuinely hazardous for a small child.

Here is each one, sorted honestly.

The one that actually works: honey

Of everything in this article, honey has the strongest evidence. Reviews of trials in children with night-time cough from ordinary viral illness find that honey reduces how much the child coughs and improves sleep for both child and parent — performing at least as well as the common cough-syrup ingredients it has been compared with, and better than no treatment.

Why it works is probably simple: it coats and soothes an irritated throat, and it stimulates saliva and mucus flow. It is also sweet, which appears to suppress the cough reflex in its own right.

Dose: roughly half to one teaspoon, plain or in warm water, at bedtime and during the day as needed.

The absolute rule: never give honey to a baby under one year. Honey can contain spores that cause infant botulism, a rare but severe paralytic illness. The infant gut cannot handle them; an older child's can. There is no brand, no boiling and no quantity that makes this safe. Under one year, honey is simply off the list.

Worth doing, even if the evidence is thin

Warm fluids. Water, soup, tea, milk, kadha — anything warm and drinkable. Thin mucus clears more easily than thick, and warmth is soothing. The effect is modest and entirely real.

Ginger, tulsi and black pepper. Traditional, plausible, and essentially harmless in culinary quantities. The laboratory work is interesting and the human trial evidence is thin, so the honest framing is: there is no good reason not to, and no promise attached.

Haldi doodh. Same category. Comforting, warm, safe. Turmeric's much-publicised anti-inflammatory activity does not survive the journey through the gut in any useful quantity, so the benefit is likely the warm milk.

Steam, for a blocked nose. Genuinely helps congestion, briefly. It does nothing for airway inflammation, and there are three situations where it causes harm — covered in steam inhalation: what it helps and what it does not.

Salt-water gargling. Helps a sore throat. Does little for a cough coming from the chest.

Raising the head of the bed. For a cough that is worse lying down, a modest incline helps, particularly where reflux is contributing.

Worth knowing the catch

Mulethi (licorice root). Widely used for cough, and it does soothe. But real licorice taken regularly or in quantity raises blood pressure, lowers potassium and causes fluid retention. If you have high blood pressure, heart or kidney disease, or are pregnant, it is not a harmless herb. Occasional use is fine; a daily habit is not.

Strong kadha, several times a day. Fine as a warm drink. Very concentrated preparations taken repeatedly can irritate the stomach, and some combinations interact with prescribed medicines. More is not better.

Stop these, particularly for children

Camphor (kapoor). Applied to the chest, burned, or added to steam. Camphor is absorbed through skin and can cause seizures in small children; poisoning is reported regularly in Indian paediatric practice. There is no benefit to weigh against it.

Camphorated and menthol rubs under the nose of a baby or toddler. The cooling sensation makes a nose feel open without opening it, and in young children these preparations can irritate the airway and increase secretions. Avoid under two years entirely.

Over-the-counter cough syrups for young children. This is the most important item in this list. Combination cough and cold syrups — the ones containing codeine, dextromethorphan, antihistamines or decongestants — are not recommended for young children. They have no demonstrated benefit for a viral cough, and they have caused real harm, including sedation, breathing difficulty and deaths. India's regulator has restricted their use in young children. Honey and fluids are not a poor substitute for them; they are a better treatment.

Antibiotics for an ordinary cough. Most coughs are viral. An antibiotic does nothing for them, causes side effects, and contributes to resistance that matters enormously in a country with as much TB and pneumonia as this one. Being prescribed one does not mean it was needed; a very large share of antibiotic prescriptions for cough in India are not.

Smoking "to clear the chest", or avoiding water or bathing. The first worsens every cough mechanism there is. The second has no basis — a warm bath is fine and often helps.

Suppressing a productive cough. If you are bringing up sputum from an infection, a cough suppressant works against you. Coughing is the clearance mechanism.

Why so many coughs last three weeks anyway

This is worth understanding, because it is usually mistaken for a remedy failing.

A viral infection damages the lining of the airway, and the nerve endings underneath are left exposed and irritable for some time after the virus has gone. The airway becomes temporarily over-reactive: cold air, dust, smoke, laughing or talking will set off a cough that has no infection behind it at all. In adults this post-viral cough commonly runs two to three weeks and sometimes longer, with everything else entirely normal.

So a cough that is slowly improving at two weeks usually needs nothing but time. What matters is the direction. Improving slowly is reassuring; static or worsening at three weeks is not.

What is usually behind a cough that will not go

If a cough has outstayed three weeks, these are the common explanations, and they are mostly treatable:

• Post-viral airway irritability, as above, which resolves on its own
• Asthma — including the version where cough is

the only symptom and there is no audible wheeze at all. It is typically worse at night, in cold air, on exertion, or during a particular season, and it is confirmed with spirometry

• Post-nasal drip from allergic rhinitis — the throat-clearing cough, with

sneezing and a blocked nose, often seasonal. Treating the nose stops the cough

• Acid reflux, which causes a dry cough worse on lying down and after

meals, frequently with no heartburn at all

• A blood-pressure tablet. ACE inhibitors cause a persistent dry cough in

a meaningful minority of people, sometimes starting months after the tablet did. It stops when the drug is changed — which only happens if someone makes the connection

• Tuberculosis, which in this country belongs on the list for any cough

past three weeks, and is found with a sputum test and an X-ray

• Smoking, or the winter air in this region — both cause a chronic cough

in their own right, and both make all of the above worse

The point is that "a cough that will not go" is a question with a short list of answers, almost all of which have a treatment. Continuing to manage it at home for three months is how a treatable cause goes unfound.

The part the remedies cannot fix

A remedy manages discomfort while an illness resolves. The risk is that it manages the discomfort of an illness that is not going to resolve.

See a doctor if:

• The cough has lasted more than three weeks
• There is any blood, even streaks
• There is weight loss, evening fever or night sweats — which in India raise the question of tuberculosis, curable and dangerous to leave
• You are breathless, or more breathless than before
• There is wheeze, or a cough that returns between infections, suggesting asthma rather than a run of colds
• You need a reliever inhaler more than twice a week
• A child is struggling to breathe, drawing in at the ribs, or too breathless to feed or speak — that is the same hour, not the next morning
• A cough started after a new medicine — some blood-pressure tablets cause a persistent dry cough

The short version

Honey after one year of age, warm fluids, and patience cover most ordinary coughs better than anything from a chemist. Skip the camphor, skip the syrup for small children, be careful with mulethi if you have blood pressure — and watch the calendar, because three weeks is the line where a cough stops being a cough and becomes a question.

For a cough that has outstayed three weeks, or one that keeps returning, book a consultation or call 8563816000.