Good Health

Revealed by a professor who’s one of Britain’s leading cough experts

Millions of us — including the Queen — have been plagued by a hacking cough this winter. A cough related to a cold occurs when the virus hijacks the cough reflex (which normally works to stop things such as food getting into the windpipe).

The virus uses this defence mechanism to spread itself further: it makes the nerves and cough receptors in the upper respiratory passages hypersensitive (this sends messages to the cough centre in the brain).

‘This causes us to cough more frequently and spread the virus around,’ explains Alyn Morice, a professor of respiratory medicine at the University of Hull and a founding member of the international society for the study of Cough.

‘An acute cough is a viral infection, and the doctor has nothing to offer you — antibiotics will not work. if you must have something, then see a pharmacist.’

so, which remedies will make a difference? last week, it was reported that bottles of sanderson’s Throat specific Mixture, a gargle popular with actors, had all but sold out amid soaring demand.

But a recent review of studies by the American Chemical society concluded that cough medicines are generally no better than a placebo.

However, Professor Morice insists that some can alleviate symptoms. Here, he offers his verdict on some popular treatments, which we then rated for their ability to stop coughs.

VICKS VAPORUB

£4.36 for 100g THis ointment contains menthol and camphor (a chemical made from turpentine oil), thought to calm a cough. EXPERT VERDICT: it’s long been known that menthol is quite effective at suppressing a cough — and this is a decent option.

Rubbing Vicks VapoRub on your chest works very quickly, and research has shown it can suppress the cough reflex for eight hours (some users also swear by rubbing it on their feet at bedtime, although i can’t see why this would help coughs).

it probably works by going to your nose and creating a cooling effect — this stimulates the receptor in the nose that picks up cold temperatures, which, in turn, seems to have a calming effect on the cough reflex. 7/10

HOMEMADE HOT HONEY AND LEMON DRINK

THe syrupy mixture works as a so-called ‘demulcent’ — it helps suppress the cough reflex by coating the throat. This calms or soothes the tickle caused by the hypersensitivity. EXPERT VERDICT: Though few scientific studies have been done, this traditional home remedy is the best option.

it’s very effective at soothing a cough if taken regularly (have a cup every hour if necessary) and it’s also cheap.

it’s especially good for children because it has natural ingredients — it’s what i give my kids when they have a cough. 10/10

BRONCHOSTOP COUGH PASTILLES

£4.99 for 20 pastilles ConTAining thyme extract, these herbal supplements aim to relieve chesty coughs as well as dry, tickly coughs and catarrh. EXPERT VERDICT: in germany, thyme is widely used for coughs and upper respiratory infections. And there’s good research to support the herb’s use — one study found that it damped down one of the prime cough receptors in the throat.

i’d suggest taking it in supplement form, rather than, say, a tea (made by adding fresh herbs to hot water). loose herbs can vary widely in preparation and strength, so the benefits you get may vary.

Tablets — which you suck — will contain a set amount from a standardised crop. sucking a lozenge is like having a linctus. 6/10

BELLS SIMPLE LINCTUS

£1.40 for 300ml THis ‘soothes mild non-specific coughs in adults’, according to the manufacturer. EXPERT VERDICT: A simple linctus — essentially a thick, sweet liquid medicine used to treat coughs and sore throats — such as this one, or a supermarket own brand, also has a demulcent effect.

it is basically the pharmaceutical version of honey and lemon, though more expensive.

All cough medicines are linctuses — some more expensive varieties have other ingredients that may make them more effective. 8/10

BOOTS PARACETAMOL AND CODEINE TABLETS

£2.19 for 32 tablets Codeine has been shown to suppress a cough by acting on the brain’s cough reflex centre — the medulla oblongata. EXPERT VERDICT: Codeine is used for mild to moderate pain and, sometimes, to reduce coughing (a derivative of it — pholcodine — is found in some cough medicines).

However, there is little good evidence to show that codeine is a viable treatment for an acute cough. The problem is that some people metabolise codeine very quickly, and others not at all, which means it will have little, if any, effect for the slow metabolisers.

if it works for you for other ailments, then it may work for a cough, but bear in mind it can have a sedative effect.

overall, there is much better evidence for other ingredients, especially dextromethorphan found in some cough syrups. 2/10

BENYLIN DRY COUGHS SYRUP

£5.39 for 150ml THis is aimed at dry, or nonproductive, coughs — so-called because they produce no phlegm. its active ingredient is dextromethorphan, and the manufacturer says that it ‘helps to suppress the cough mechanism’. EXPERT VERDICT: if your cough is driving you mad, go for a linctus with extra ‘oomph’, such as this one. Although the labels on products claim there are different types of cough, this is essentially a marketing gimmick. All acute coughs and colds — defined as being less than three weeks in duration — are classed as viral respiratory infections, whether or not you produce phlegm.

This cough syrup contains dextromethorphan, which has been shown to be the most effective ingredient at stopping coughs, though it may make you drowsy.

The drug acts directly on the cough centre in the brain, raising the ‘cough threshold’, the level of irritation that triggers coughing.

The recommended daily amount of this is 30-60mg.

But an adult can generally take up to 60mg in one go — that’s the recommended limit for 24 hours, but the effect has been shown to last that long, suppressing the cough reflex by 15 to 20 per cent.

it’s the method i use. But it only applies to a standalone cough remedy such as this.

never do this with products containing multiple ingredients, such as paracetamol. 7/10

UNICOUGH ORAL SOLUTION

£12.95 for 300ml WiTH the active ingredients diphenhydramine hydrochloride, ammonium chloride and levomenthol, this solution is said to provide ‘effective relief of common coughs’, both dry and chesty. EXPERT VERDICT: This is the first product to enter the cough market since the Fifties (it launched last year). The syrup is a thick cocoa mixture, which has a high demulcent effect, and many people like the taste.

it’s more viscous than standard cough medicines, and so forms an even thicker coating, protecting nerve endings in the throat against irritation.

its stickiness also ensures the calming ingredients — which include diphenhydramine, another drug that directly deactivates the cough centre in the brain — are in contact with sensitised nerve endings for as long as possible.

A well-designed trial into it found that patients taking Unicough had a significant improvement in symptoms within two days.

Their coughs lasted 1½ to two days less than those taking a standard linctus.

drinking hot cocoa won’t have the same effect, because the cocoa isn’t in contact with the throat long enough. 8/10

FISHERMAN’S FRIEND ORIGINAL LOZENGES

99p for 45g THese traditional, extra-strong lozenges contain menthol, eucalyptus, liquorice powder and capsicum. EXPERT VERDICT: What’s interesting here is the use of capsicum, or chilli pepper. While this can make us cough, it can also encourage calming secretions in the throat, which can soothe a cough.

(sanderson’s Throat specific Mixture — favoured by actors — also contains capsicum, but i don’t think it would be as effective as a lozenge because it doesn’t stay in the mouth as long.)

essentially, it causes the receptor that stimulates a cough to be ‘switched off’.

A spicy meal may, theoretically, have the same effect.

sucking a lozenge coats the throat, while menthol and eucalyptus can help suppress the cough reflex. 6/10

COVONIA ORIGINAL BRONCHIAL BALSAM

£4.55 for 150ml ConTAining dextromethorphan and menthol, the manufacturer says this has a ‘rapid impact’ on dry coughs and irritation in the throat and chest. EXPERT VERDICT: A balsam is basically a linctus. This also contains dextromethorphan, which, evidence indicates, can reduce the symptoms of acute cough by around 20 per cent. 8/10