--- topic: "Cough Remedies" title: "What Actually Calms a Cough" order: 1 description: "What research says about honey, ivy, thyme, Pelargonium and shop-bought syrups for cough, how long a cough normally lasts, and when to see a doctor." question: "What actually calms a cough: honey, herbs, steam, or syrups?" answer: "Honey likely eases night cough in children over one; ivy, thyme and Pelargonium help slightly in low-quality trials; shop-bought cough medicines lack good evidence." actions: - "For a night cough in a child over 12 months, a spoonful of honey at bedtime is cheap; one trial used a single 10 g dose in ages 1–5 [1][3]." - "Plan on time: in studies of adults, a cough lasted 17.8 days on average, far longer than most people expect [10]." - "For an herbal syrup, ivy leaf, thyme-ivy or Pelargonium products have small trials showing modest benefit; ask a clinician first if pregnant, on regular medicines or treating a child [7][8][9]." cautions: - "Never give honey to a baby under 12 months; it can carry botulism spores [5]." - "Do not give over-the-counter cough and cold medicines to young children without medical advice: in trials they were no better than placebo, and some can cause serious harm [6]." - "Get a cough checked after 8 weeks (4 in children), if it starts suddenly in a toddler (possible inhaled object), or brings blood, breathlessness, chest pain or poor growth [11]." confidence: 3 confidenceNote: "Honey has moderate-certainty support in children but one recent trial found no benefit; herbal syrups rest on low-quality trials, and over-the-counter medicines lack good evidence." evidenceSummary: rctCount: 4 observationalCount: 1 metaAnalysisCount: 5 totalParticipants: "900+ in the trials named; 4,835 in the over-the-counter review" replicated: false newestStudyYear: 2022 references: - id: "1" pmid: "29633783" title: "Honey for acute cough in children" authors: "Oduwole O, Udoh EE, Oyo-Ita A, et al." year: 2018 journal: "Cochrane Database Syst Rev" - id: "2" pmid: "18056558" title: "Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents" authors: "Paul IM, Beiler J, McMonagle A, et al." year: 2007 journal: "Arch Pediatr Adolesc Med" - id: "3" pmid: "22869830" title: "Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study" authors: "Cohen HA, Rozen J, Kristal H, et al." year: 2012 journal: "Pediatrics" - id: "4" pmid: "35927828" title: "Multicentre, randomised study found that honey had no pharmacological effect on nocturnal coughs and sleep quality at 1-5 years of age" authors: "Nishimura T, Muta H, Hosaka T, et al." year: 2022 journal: "Acta Paediatr" - id: "5" pmid: "12432974" title: "Association between honey consumption and infant botulism" authors: "Tanzi MG, Gabay MP" year: 2002 journal: "Pharmacotherapy" - id: "6" pmid: "25420096" title: "Over-the-counter (OTC) medications for acute cough in children and adults in community settings" authors: "Smith SM, Schroeder K, Fahey T" year: 2014 journal: "Cochrane Database Syst Rev" - id: "7" pmid: "24146345" title: "Pelargonium sidoides extract for treating acute respiratory tract infections" authors: "Timmer A, Günther J, Motschall E, et al." year: 2013 journal: "Cochrane Database Syst Rev" - id: "8" pmid: "17063641" title: "Efficacy and tolerability of a fluid extract combination of thyme herb and ivy leaves and matched placebo in adults suffering from acute bronchitis with productive cough. A prospective, double-blind, placebo-controlled clinical trial" authors: "Kemmerich B, Eberhardt R, Stammer H" year: 2006 journal: "Arzneimittelforschung" - id: "9" pmid: "33523253" title: "Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review" authors: "Sierocinski E, Holzinger F, Chenot JF" year: 2021 journal: "Eur J Clin Pharmacol" - id: "10" pmid: "23319500" title: "How long does a cough last? Comparing patients' expectations with data from a systematic review of the literature" authors: "Ebell MH, Lundgren J, Youngpairoj S" year: 2013 journal: "Ann Fam Med" - id: "11" pmid: "31515408" title: "ERS guidelines on the diagnosis and treatment of chronic cough in adults and children" authors: "Morice AH, Millqvist E, Bieksiene K, et al." year: 2020 journal: "Eur Respir J" - id: "12" pmid: "32817011" title: "Effectiveness of honey for symptomatic relief in upper respiratory tract infections: a systematic review and meta-analysis" authors: "Abuelgasim H, Albury C, Lee J" year: 2021 journal: "BMJ Evid Based Med" --- Honey is the best-studied home remedy for cough, mainly for night cough in children over one year, though results are mixed and the benefit is modest [1][4]. Ivy, thyme and Pelargonium syrups have small trials behind them [7][8][9]. Shop-bought cough medicines lack good evidence [6]. Most coughs fade in two to three weeks without treatment [10]. Never give honey to babies under 12 months [5]. ## How it works ### Time does most of the work Most coughs follow a cold or other viral infection and fade by themselves. Across studies of otherwise healthy adults, the average cough lasted 17.8 days, while people surveyed expected about a week. The authors argue that this mismatch feeds antibiotic overuse for coughs [10]. ### Honey For children aged 12 months and over, honey probably reduces cough more than no treatment or placebo, and may do about as well as dextromethorphan. Most trials gave one night's dose, and the review authors saw no strong evidence either way [1]. In single-dose trials, parents rated honey better than no treatment among 105 children aged 2 to 18, and better than a date-syrup placebo among 300 children aged 1 to 5 [2][3]. A newer Japanese trial of 161 children aged 1 to 5 found honey no better than a honey-flavored syrup [4]. A 2021 meta-analysis of 14 studies found honey beat usual care for cough frequency and severity, but placebo-controlled data were limited [12]. Honey must never be given to babies under 12 months [5]. ### Herbal syrups An updated review of ivy leaf trials found that all favored it, but the effects were minimal and of uncertain clinical importance, with a high risk of bias [9]. A thyme-ivy syrup cut coughing fits by 68.7% versus 47.6% on placebo in 361 adults with acute bronchitis [8]. Liquid Pelargonium sidoides extracts helped bronchitis symptoms in low-quality trials; side effects were more common with the extract but not serious [7]. See [Pelargonium sidoides](/pelargonium-sidoides/respiratory-infections-and-immune-support), and [which herbs interact with medications](/herb-drug-interactions/which-herbs-interact-with-medications). ### Shop-bought cough medicines A Cochrane review of 29 trials (4,835 people) found no good evidence for or against over-the-counter cough medicines. In children, cough suppressants, antihistamines and antihistamine-decongestants were no better than placebo, and the authors warned that some of these drugs can cause serious harm in children [6]. ### When a cough needs a clinician Guidelines call a cough chronic after 8 weeks in adults and 4 weeks in children, and it needs assessment. In a healthy toddler, a sudden cough may mean an inhaled object. In children, coughing up blood, breathlessness, chest pain and poor growth are listed as signs of a specific cause, and in adults the guideline advises checking for infection, malignancy and ACE inhibitor use (a blood-pressure drug) [11]. For steam, see [does breathing steam help a cold](/steam-inhalation/does-breathing-steam-help-a-cold). ## The evidence in detail ### Honey The 2018 Cochrane review pooled six randomized trials in 899 children aged 12 months to 18 years. On a 7-point scale, honey lowered cough frequency by a mean difference of -1.05 against no treatment (95% CI -1.48 to -0.62; 154 children; moderate certainty) and -1.62 against placebo (95% CI -3.02 to -0.22; 402 children). It did not differ clearly from dextromethorphan (mean difference -0.07; low certainty) and may have beaten diphenhydramine (-0.57; one study of 80 children; low certainty). Beyond three days, honey had no advantage over placebo or salbutamol [1]. Paul and colleagues randomized 105 children aged 2 to 18 with colds to buckwheat honey, honey-flavored dextromethorphan or nothing. Honey was better than no treatment for cough frequency and the combined score; dextromethorphan was not better than no treatment on any outcome, and honey and dextromethorphan did not differ significantly [2]. Cohen and colleagues randomized 300 children aged 1 to 5 to 10 g of eucalyptus, citrus or labiatae honey or a date-extract placebo; every group improved overnight, but improvement was greater with honey [3]. The 2021 meta-analysis of 14 studies reported a mean difference of -3.96 on a combined symptom score (3 studies), and standardized differences of -0.36 for cough frequency (8 studies) and -0.44 for severity (5 studies) against usual care; the two studies against placebo were not significant (-0.63; 95% CI -1.44 to 0.18) [12]. ### Where honey results conflict The pediatric trials mostly relied on parent ratings after one or two nights, and every group, placebo included, improved as the illness ran its course. In the Japanese multicenter trial, 78 children got acacia honey and 83 a honey-flavored syrup for two nights; both improved, with no significant difference [4]. One possible explanation is that the placebos were themselves sweet syrups, so part of any soothing effect was shared by both arms. The Cochrane authors concluded there was no strong evidence for or against honey [1]. ### Herbal products Kemmerich and colleagues ran an 11-day double-blind trial in 361 adults with acute bronchitis, comparing thyme-ivy syrup (n=182) with placebo (n=179). Coughing fits fell by 68.7% on days 7 to 9 versus 47.6% on placebo (p<0.0001), a 50% reduction came two days sooner, and responder rates were 96.2% versus 74.7% at the end of treatment; there were no serious adverse events [8]. The updated ivy leaf review found six randomized trials, one controlled trial and four observational studies; all favored ivy, three randomized trials showed faster improvement, but reporting quality was low and the clinical significance minimal [9]. The Pelargonium Cochrane review included eight of ten eligible trials. Three trials in 746 adults and three in 819 children with acute bronchitis favored the liquid extract but not tablets, and the authors rated the evidence low quality and suspected publication bias. One sinusitis trial (103 adults) showed a significant effect on complete resolution at day 21 (RR 0.43, 95% CI 0.30 to 0.62), at very low quality [7]. ### Over-the-counter medicines Smith and colleagues could not pool 29 placebo-controlled trials (19 in adults, 10 in children) because they differed too much. In adults, results were variable: one of three guaifenesin trials showed benefit, and three trials found antihistamines no better than placebo. In children, cough suppressants (three trials), antihistamines (three) and antihistamine-decongestants (two) were no better than placebo. Adverse effects were more common with antihistamine and dextromethorphan products [6]. ### How long and how worrying Ebell and colleagues surveyed 493 adults and found a median expected cough duration of 5 to 7 days, while the systematic review of published studies found a mean of 17.8 days [10]. The European Respiratory Society guideline notes that recent guidelines use 8 weeks in adults and 4 weeks in children as the threshold for chronic cough, describes foreign body inhalation as a cause of sudden cough in healthy preschool children, and advises excluding infection, malignancy and ACE inhibitor use in adults [11]. ### Bottom line Confidence is moderate to low (3 of 5). Honey probably gives modest relief of night cough in children over one year [1][2][3], though a recent trial did not reproduce it [4]. Ivy, thyme and Pelargonium products may help slightly, based on low-quality trials [7][8][9]. Over-the-counter cough medicines lack good evidence [6]. Time, and attention to red flags, matter most [10][11].