Cough management: a practical approach

Abstract

Cough is one of the most common symptoms for which patients seek medical attention from primary care physicians and pulmonologists. Cough is an important defensive reflex that enhances the clearance of secretions and particles from the airways and protects the lower airways from the aspiration of foreign materials. Therapeutic suppression of cough may be either disease-specific or symptom related. The potential benefits of an early treatment of cough could include the prevention of the vicious cycle of cough. There has been a long tradition in acute cough, which is frequently due to upper respiratory tract infections, to use symptom-related anti-tussives. Suppression of cough (during chronic cough) may be achieved by disease-specific therapies, but in many patients it is often necessary to use symptomatic anti-tussives, too. According to the current guidelines of the American College of Chest Physician on "Cough Suppressants and Pharmacologic Protussive Therapy" and additional clinical trials on the most frequent anti-tussive drugs, it should be possible to diagnose and treat cough successfully in a majority of cases. Among drugs used for the symptomatic treatment of cough, peripherally acting anti-tussives such as levodropropizine and moguisteine show the highest level of benefit and should be recommended especially in children. By improving our understanding of the specific effects of these anti-tussive agents, the therapeutic use of these drugs may be refined. The present review provides a summary of the most clinically relevant anti-tussive drugs in addition to their potential mechanism of action.

Figure 1

The acute cough algorithm for the management of patients aged ≥15 years with cough lasting < 3 weeks. PE = pulmonary embolism; Dx = diagnosis; Rx = treatment; URTI = upper respiratory tract infection; LRTI = lower-respiratory tract infection. Taken from Ref [61] with permission from the publisher.

Figure 2

Sub acute cough algorithm for the management of patients aged > 15 years with cough lasting 3 to 8 weeks. See the legend of Figure 1 for other section references. Taken from Ref [61] with permission from the publisher.

Figure 3

Chronic cough algorithm for the management of cough ≥15 years of age with cough lasting > 8 weeks. ACE-I; ACE-inhibitor; BD = Bronchodilator; LTRA = Leukotrienes receptor antagonist; PPI = Proton Pump Inhibitor. Taken from Ref [61] with permission from the publisher.