Pharmacologic management of cough

Abstract

This review is an update of recent advances in our understanding of cough suppressants and impairment of cough. Low-dose oral morphine has recently been shown to significantly suppress chronic cough, but the side effect profile of this opioid may limit its widespread utility. Several studies have demonstrated a dissociation between the efficacy of antitussives in some metrics of pathologic cough and their effects on cough sensitivity to inhaled irritants. The relevance of widely used inhaled irritants in understanding pathologic cough and its response to antitussives is questionable. A recent advance in the field is the identification and measurement of an index of sensation related to cough: the urge to cough. This measure highlights the potential involvement of suprapontine regions of the brain in the genesis and potential suppression of cough in the awake human. There are no new studies showing that mucolytic agents are of value as monotherapies for chronic cough. However, some of these drugs, presumably because of their antioxidant activity, may be of use as adjunct therapies or in selected patient populations. The term dystussia (impairment of cough) has been coined recently and represents a common and life-threatening problem in patients with neurologic disease. Dystussia is strongly associated with severe dysphagia and the occurrence of both indicates that the patient has a high risk for aspiration. No pharmacologic treatments ae available for dystussia, but scientists and clinicians with experience in studying chronic cough are well qualified to develop methodologies to address the problem of impaired cough.