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 pathological cough and their effects on cough sensitivity to inhaled irritants. The relevance of widely used inhaled irritants in understanding pathological 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 may be of use as adjunct therapies or in selected patient populations, presumably due to their antioxidant activity. The term dystussia (impairment of cough) has been coined recently and represents a common and life-threatening problem in patients with neurological disease. Dystussia is strongly associated with severe dysphagia and the occurrence of both indicates that the patient has a high risk for aspiration. There are no pharmacological treatments for dystussia, but the community of scientists and clinicians that have experience in studying chronic cough is uniquely well qualified to develop methodologies that enhance impaired cough. KeywordsCough; Antitussive; Cough suppressant; Dystussia; Atussia; Dysphagia The purpose of this review is to provide an update on advances in the pharmacology of cough and antitussives. There are a number of informative reviews on recent work in the area of antitussives [1][2][3][4][5][6][7] . These reviews note the limited amount of new information that has become available on the effects of these drugs in humans in the last several years. Furthermore, there are no new drugs that have been shown to be effective as antitussive agents in double-blind placebo controlled trials in humans with chronic or acute cough [2][3][4][5][6] . This review will focus on some new information on antitussives. The review is expanded to include the potential therapeutic impact of enhancement of cough in patients that suffer from dystussia 8 , or impaired cough.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptOtolaryngol...

Dysphagia, dystussia, and aspiration pneumonia in elderly people

“…Such elderly people were revealed to have almost no response to tussive stimuli (38,42). An inability to cough with tussive stimuli is called atussia, which is the ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration (43).…”

Tosse: neurofisiologia, métodos de pesquisa, terapia farmacológica e fonoaudiológica

“…A enzima conversora da angiotensina (ECA) degrada não apenas a angiotensina I, mas também a bradicinina, substância P e neurocininas, as quais sensibilizam fibras C. Por esse motivo, cerca de 20% dos pacientes que usam anti-hipertensivos inibidores da ECA têm tosse como efeito colateral (1,24). O sintoma tende a desaparecer cerca de quatro semanas após a interrupção do uso do antihipertensivo (25).…”

“…Estudos clínicos mostram que a monoterapia com nacetilcisteína ou erdosteína não tem efeito antitussígeno, mas os mucolíticos são bons coadjuvantes no tratamento de afecções respiratórias, presumivelmente pelo seu efeito antioxidante (25).…”

“…Várias marcas comerciais de antitussígenos isentos de prescrição médica associam a dropropizina, a levodropropizina ou o dextrometorfano com antihistamínicos H1 clássicos (difenidramina, doxilamina) na formulação. Esses anti-histamínicos ajudam a aliviar a tosse graças à sua ação periférica e ao controle da atopia, mas seu efeito no SNC causa sonolência (25).…”

Potent cough suppression by physiologically active substance in human plasma

“…Therefore our observations suggest that fXIa suppresses the cough induced by "cough receptors", RARs and nociceptor Aδ and c-fibers that are insensitive to codeine. Recent reviews highlighted the prominent shortcomings of current available antitussives, including narcotic opioids such as codeine and their unpleasant or intolerable side effects (Dicpinigaitis 2009;Bosler 2010). Furthermore in a double-blind, placebo-controlled, crossover study, 60 mg of codeine in coughing subjects with chronic obstructive pulmonary disease (COPD), experienced no benefit with codeine over placebo in response to citric acid in measures of objective cough frequency or subjectively assessed cough and cough reflex sensitivity .…”