As a symptom of an underlying condition,
cough is one of the most common reasons patients see physicians. To the majority, a
cough means that 'something is wrong' and it causes exhaustion and/or self-consciousness. Patients find these reasons as well as effects on lifestyle, fear of
cancer and/or
AIDS or
tuberculosis to be the most troublesome concerns for which they seek medical attention. The treatment of
cough can be divided into two main categories: (a)
therapy that controls, prevents or eliminates
cough (i.e.
antitussive); and (b)
therapy that makes
cough more effective (i.e. protussive).
Antitussive therapy can be either specific or nonspecific. Definitive or specific
antitussive therapy depends on determining the aetiology or operant pathophysiological mechanism, and then initiating specific treatment. Since the cause of
chronic cough can almost always be determined, it is possible to prescribe specific
therapy that can be almost uniformly successful. Non-specific
antitussive therapy is directed at the symptom; it is indicated when definitive
therapy cannot be given. Practically speaking, the efficacy of nonspecific
therapy must be evaluated in double-blind, placebo-controlled, randomised studies of pathological
cough in humans. Such studies have demonstrated the efficacy of
dextromethorphan,
codeine and
ipratropium bromide aerosol in patients with
chronic bronchitis. While the preferred treatment for patients with
cough due to
angiotensin converting enzyme (
ACE) inhibitor therapy is withdrawal of the offending drugs, it may be possible to ameliorate the
cough by adding
nifedipine,
sulindac or
indomethacin to the treatment regimen. The efficacy of protussive
therapy has not been well documented. Although hypertonic saline
aerosol and
erdosteine in patients with
bronchitis, and
amiloride aerosol in patients with
cystic fibrosis have been shown to improve mucus clearance, their clinical utility has not been adequately studied.