Clinical and pharmacological approaches to the optimisation of therapy in a coughing patient

Abstract

Cough is considered as an unconditional reflex adaptive defense response to irritating agents such as aeropollutants, foreign bodies, sputum, and is supposed to ensure adequate airway patency for normal gas exchange. Unfortunately, this mechanism is often transformed from a protective to a pathological one, lacking an adaptive function, causing suffering to the patient and exacerbating his poor condition. The line between physiological and pathological cough is often blurred and is perceived differently by both patients and physicians. In most cases, cough, including persistent cough, is treated with neglect by the general population - as an everyday occurrence with no major problems, and with a lack of awareness of tuberculosis, cancer and a number of other serious diseases. There are a large number of medicines on the market that are positioned as effective cough medicines. However, the wide variety of ways to treat this pathology demonstrates that there is no ideal cough medicine that combines universality, high efficacy and safety. Many drugs can cause serious side-effects, imposing severe restrictions on their use. Another difficulty is that the triggers and pathways of the cough reflex are extremely varied. Identifying the causes of persistent cough requires a thorough medical history, often with a multidisciplinary approach: extended examination, doctors such as otorhinolaryngologist, cardiologist, gastroenterologist, pulmonologist, oncologist, phthisiatrician, clinical pharmacologist (druginduced cough, drug-drug interactions). This article focuses on the differential diagnosis of cough and the selection of cough medicines based on their proven efficacy and safety. This information becomes particularly relevant during the seasonal increase in the incidence of acute respiratory infections.