The inability to clear mucus is a major contributor to discomfort in flu and cold patients, but there are many over-the-counter (OTC) medications that can relieve congestion symptoms.

Aside from antivirals, which only reduce the duration of influenza, treatment is largely focused on symptoms. Patients with colds and influenza frequently turn to OTC medications to relieve their cough and congestion symptoms.4 Nurse practitioners (NPs) and PAs are in an ideal position to guide patients to the most appropriate OTC treatments based on their most bothersome symptoms, pre-existing medical conditions, and current medications. They can also provide guidance about the different classes of OTC mucoactive drugs (ie, those that alter either the viscoelastic properties and/or promote secretion or expulsion of mucus). Mucoactive medications include expectorants, mucoregulators, mucolytics, and mucokinetics.

Globally, over 50 mucoactive compounds are available; in the United States, the Food and Drug Administration (FDA) has approved only 2 for this purpose: guaifenesin, an expectorant; and N-acetylcysteine, a mucolytic.

Expectorants target mechanisms that promote increased mucus hydration and clearance from the respiratory tract by making coughs more productive and reducing cough reflex sensitivity.23 The only FDA-approved OTC expectorant is guaifenesin, which is thought to work by reducing the viscosity of secretions in the trachea and bronchi as well as stimulating the flow of respiratory tract secretions, allowing ciliary movement to carry the loosened secretions toward the pharynx.24 The precise mechanism by which expectorants exert their action is unclear, although they may act as irritants to gastric vagal receptors, and recruit efferent parasympathetic reflexes that induce glandular exocytosis of a less viscous mucus mixture.25

It has been suggested that expectorants may have a role as a prophylactic agent in the fight against COVID-19.26 Similar benefits may be seen in treatment of mild cases of COVID-19; however, studies are currently lacking.

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