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Preclinical and Clinical Investigation of Drugs II. Antitussive Drugs

Interest in antitussive drugs continues to grow, yet the fundamental concept of the mode of action of these drugs remains essentially unchanged. For example, codeine, the prototype of centrally-acting antitussives, suppresses the cough reflex by depressing the cough center in the medulla. Numerous other drugs have been introduced as clinically useful antitussives, almost all of which have a mode of action similar to that of codeine. A review of the literature on antitussive drugs has revealed a series of observations which are not in conformity with the above simple thesis of an action of antitussive drugs on the central nervous system (CNS). These observations emphasize the possibility of blocking cough with drugs having a primary bronchodilator action and a secondary peripheral antitussive action. Correlation of bronchodilatation with antitussive activity led to the “Bronchomotor Theory”1 concerning the initiation of the cough reflex, viz., that the cough reflex is initiated by a bronchoconstriction, and that a drug which relaxes the bronchial musculature could prevent the cough reflex.