This is the protocol for a Cough:




Let’s break it down!

A cough is defined as a “sudden expulsion through the large breathing passages”, primarily for the purpose of clearing out fluids, irritants, foreign particles, microbes….you name it. It’s not a condition in itself, but rather a symptom of something greater.  As the protocol states, it’s typically a virus that causes this irritation in the throat.  From an evolutionary perspective, it actually benefits the virus to induce coughing in its host because it helps spread the disease to new hosts. 

But not every cough is caused by a virus.  The proper treatment for cough also includes ruling out the more dangerous causes of cough, like high altitude pulmonary edema (HAPE), pneumonia, etc.  That’s why you should never start treating a cough w/o doing a quick history and physical exam.

For more on the pathophysiology of the coughing mechanism, check out the video below:

Coughs are commonly associated with upper respiratory infections (URI).  The mucous production from things like allergic rhinitis often drains into the back of the throat and tickles the lining of the throat, causing a “dry cough“.  On the flip side, for things like bronchitis and pneumonia, you’ll find that the patients will have a productive or “wet cough“.  This is less of a tickle and more of a design to help expel mucous out of the lungs. 

These are just a few examples, but diagnosing the type of cough the patient has can become quite a science, especially if you’re dealing with kids.  Check out the video below:


1. If the cough is productive, do not treat unless the cough is restricting sleep

Coughing isn’t inherently a bad thing.  It’s designed to help expel unwanted foreign material.  So if the cough successful at getting rid of excess mucous, don’t treat it! The exception, of course, being if the patient isn’t able to sleep at night because of the cough.

2.   Increase PO hydration

Increasing fluid intake helps decrease the viscosity of the mucous, thus making the patient much more comfortable.  Plus, staying well hydrated is always a good idea.

Not drinking enough water? This is how it can harm your body ...

3. Avoid respiratory irritants (smoke, aerosols, etc.)

Not every cough comes from an infectious process.  Often times it’s the irritants in the environment that are causing the problem.  Removing the patient from the source is an easy fix. 

Why Does Marijuana Make You Cough? • Green Rush Daily

Cepacol lozenges or “cough drops” are a safe, easy way to help push through the discomfort of a cough.  Most lozenges contain two primary active ingredients: menthol and benzocaine.  The menthol helps increase saliva in the throat as well as provide a “cooling” effect.  The benzocaine is a local anesthetic that numbs the painful area.  Sometimes, Cepacol lozenges will contain dextromethorphan, which works on the brain to help suppress the coughing reflex. 

Image result for cepacol active ingredients





There are only two antitussive (“anti-cough”) drugs available within our scope: Benzonatate and Dextromethorphan.  Some notes about both:


It’s like lidocaine for your throat.  Inside the little pearls is a local anesthetic that decreases the sensitivity of stretch receptors in the lower airway and lung, thereby reducing the drive to cough after taking a deep breath.  It’s desired over something like dextromethorphan because it’s a non-narcotic agent that’s less likely to be abused. 



Chemically related to morphine, it works on the central nervous system to help suppress the coughing reflex.  This is the only over-the-counter antitussive option for patients on the civilian side.  It’s an active ingredient in several brand medications: Nyquil, Robitussin, etc.  Some patient’s have success with it, but controlled studies have found the symptomatic effectiveness of dextromethorphan to be similar to placebo  

Albuterol is a bronchodilator that helps relax the muscles in the bronchioles to reduce the frequency of bronchospasms.  It can be a helpful agent if the cough is secondary to a lower respiratory infection like bronchitis or pneumonia.

Image result for albuterol inhaler






Speaking of which… if the patient is febrile or has any chest pain w/ productive cough, then you’ll know that you have to switch over to the Bronchitis/Pneumonia protocol.  Be sure to always auscultate the lung fields for any cough patient so that you don’t miss this.  

Image result for bronchitis

It’s just a cough, you got this!

Good luck out there!



  • Chung KF, Pavord ID (April 2008). “Prevalence, pathogenesis, and causes of chronic cough”. Lancet371 (9621): 1364–74. doi:10.1016/S0140-6736(08)60595-4
  • Pavord ID, Chung KF (April 2008). “Management of chronic cough”. Lancet371 (9621): 1375–84. doi:10.1016/S0140-6736(08)60596-6
  • Van Amburgh JA. “Do Cough Remedies Work?”Medscape. Retrieved 10 April 2016.
  • Advanced Tactical Paramedic Protocols Handbook. 10th ed., Breakaway Media LLC, 2016.
Brandon Simpson, PA-C
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