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.

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

“…Incluyen infecciones por ciertos microorganismos específicos, como Bordetella pertussis o Mycoplasma pneumoniae, hiperreactividad de la vía aérea posinfecciosa, reflujo gastroesofágico e insuficiencia cardíaca congestiva subclínica 4 .…”

“…Diversos algoritmos se han propuesto para el enfrentamiento diagnóstico de la tos crónica 4,8,17,18 . En ocasiones puede resultar un desafío diagnóstico, incluso para el especialista, por lo que debe mantenerse un elevado índice de sospecha, en particular en los cuadros prolongados, para descartar precozmente causas graves.…”

“…Resulta relevante determinar el tiempo de evolución y la edad del paciente 4,19 . Debe interrogarse dirigidamente por la presencia de síntomas compatibles con las patologías más probables, que ya se mencionaron.…”

“…Se incluyen también, antecedentes médicos, uso de medicamentos, en particular inhibidores de la enzima convertidora de angiotensina (iECA), exposición a tabaco y otros irritantes ambientales, infección respiratoria alta reciente, junto con un examen otorrinolaringológico completo, en función de establecer la etiología. Además, resulta mandatorio examinar el corazón y pulmones 4 .…”

“…El principal objetivo del tratamiento debe ser el adecuado manejo de la causa subyacente, sin embargo, en ocasiones puede ser necesario un enfoque sintomático 4 .…”