In the past, I have stressed that cough syrups have no more a role to play in patients having clinical symptoms of cough or dyspnoea, all of whom should be treated with inhalers rather than cough syrups.

Over the years, I have noticed that many patients having cough due to upper respiratory virus infection and associated viral cold, ask for a cough syrup to suppress the cough, which is acceptable.

There is another group of patients, who have mild viral bronchitis, which is not allergic in nature because it gradually subsides and disappears within a week. Since these patients have a very short and acute illness, they get shaken up if they are prescribed inhalers for their chest symptoms as in the mind of the public these inhalers are normally prescribed for ‘chronic asthma’. Such patients can be given expectorant cough syrups, which will liquefy the sputum and bring it out rather than suppressing it, though steam inhalations can do the same job. Often these patients themselves ask for cough syrups.

Finally, patients with an incurable disease of the lungs and pleura like malignancy or lymphoma, very bad MDR Tuberculosis or very progressive interstitial lung disease (ILD) need suppressive cough syrups containing codeine so that they can live a comfortable life.