Treatment of Khansi (Cough / खाँसी)

"Khansi" (खाँसी) is the Nepali/Hindi term for cough. Treatment depends on the duration and underlying cause.

Classification by Duration

Type	Duration	Common Causes
Acute	< 3 weeks	Respiratory tract infection (viral URTI, cold), aspiration, smoke inhalation
Subacute	3–8 weeks	Post-viral tussive syndrome, pertussis, post-tracheobronchitis
Chronic	> 8 weeks	Asthma, GERD, post-nasal drip, COPD, TB, malignancy, ACE inhibitor use

1. Treat the Underlying Cause (Most Important)

Viral URTI → Supportive care (rest, fluids, steam inhalation)
Bacterial infection → Appropriate antibiotics (e.g., amoxicillin for pneumonia)
Asthma → Inhaled corticosteroids (ICS) + bronchodilators (salbutamol)
GERD → Proton pump inhibitors (omeprazole), dietary changes
Post-nasal drip / allergic rhinitis → Antihistamines, intranasal steroids
TB → Standard DOTS regimen (HRZE)
ACE inhibitor-induced cough → Stop the ACE inhibitor, switch to ARB

2. Symptomatic / Cough Suppressant Treatment

(According to Harrison's Principles of Internal Medicine, p. 1127)

Narcotic Cough Suppressants (Most Potent)

Codeine, hydrocodone, morphine
Act on the "cough center" in the brainstem
Limitations: drowsiness, constipation, addiction potential
Not suitable for long-term use

Non-Narcotic Suppressants

Dextromethorphan (DXM) — OTC; centrally acting; fewer side effects than codeine; slightly less effective; different site of action, can be combined with codeine if needed
Benzonatate — locally acting; numbs stretch receptors in airways

Inhaled Therapies (for chronic idiopathic cough)

Inhaled corticosteroids (ICS)
Inhaled anticholinergic bronchodilators
Macrolide antibiotics (e.g., azithromycin)
Note: These have been tried for chronic idiopathic cough without consistent success

3. Home Remedies (Supportive)

Honey — especially effective in children (do NOT give to children < 1 year)
Ginger tea with tulsi — traditional soothing remedy
Steam inhalation — loosens mucus in productive cough
Salt water gargling — reduces throat irritation
Warm fluids — soothe the airway and thin secretions
Lozenges — provide temporary relief

4. When to See a Doctor

Seek medical attention if cough is accompanied by:

Blood in sputum (hemoptysis)
High fever
Significant weight loss
Difficulty breathing
Lasting > 3 weeks without improvement
Night sweats (possible TB)

Key principle: Treating the root cause is always more effective than suppressing the cough alone. Cough is a protective reflex — in productive (wet) cough, suppression may not always be appropriate.

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