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Covid-19 Primary Care Resources


Managing cough



Information for patients on managing cough, and GP guidelines from NICE

This information is sourced from Homerton University Hospital NHS Foundation Trust:

The ACERs team at Homerton Hospital have produced a Post Covid-19 patient information pack which includes a section on:

Strategies to manage a dry or productive cough and exercises and positions to help clear your chest

This information is sourced from NICE:

This rapid guideline is for managing Covid 19 symptoms including at the end of life

  • Be aware that older patients or those with comorbidities, frailty, impaired immunity or a reduced ability to cough and clear secretions are more likely to develop severe pneumonia
  • If possible, encourage patients with cough to avoid lying on their back because this makes coughing ineffective
  • Use simple measures first, including getting patients with cough to take honey (for patients aged over 1 year)
  • For patients with Covid-19 consider short-term use of codeine linctus, codeine phosphate tablets or morphine sulfate oral solution to suppress coughing if it is distressing

Treatments for managing cough in adults aged 18 years and over including at the end of life

Treatment
Dosage
Initial management: 
use simple non-drug measures, for example taking honey
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A teaspoon of honey
First choice, only if cough is distressing:
codeine linctus (15 mg/5 ml)
or codeine phosphate tablets (15 mg, 30 mg)
15 mg to 30 mg every 4 hours as required, up to 4 doses in 24 hours

If necessary, increase dose to a maximum of 30 mg to 60 mg 4 times a day (maximum 240 mg in 24 hours)

Second choice, only if cough is distressing: 
morphine sulfate oral solution (10 mg/5 ml)
2.5 mg to 5 mg when required every 4 hours

Increase up to 5 mg to 10 mg every 4 hours as required

If the patient is already taking regular morphine increase the regular dose by a third

Notes:

  • See BNF and MHRA advice for appropriate use and dosing in specific populations.
  • All doses are for oral administration.
  • Consider addiction potential of codeine linctus, codeine phosphate and morphine sulfate. Issue as an ‘acute’ prescription with a limited supply. Advise the person of the risks of constipation and consider prescribing a regular stimulant laxative.
  • Avoid cough suppressants in chronic bronchitis and bronchiectasis because they can cause sputum retention.
  • Seek specialist advice for patients under 18 years old.

DOWNLOADS

Homerton Hospital Post-COVID-19-information-pack.pdf