pulmonary disorders
Cough in Adults
Treatment of Cough
Treatment is management of the cause ( Treatment reference ). There is little evidence to support the use of cough suppressants or mucolytic agents. Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections. Therefore, although patients often expect or request cough suppressants, such treatment should be given with caution and reserved for patients with a URI and for patients receiving therapy for the underlying disorder for whom cough is still troubling. Cough suppressants may help some patients with chronic cough who have a reflex or psychogenic component to their cough or who develop bronchial mucosal injury. Antitussivesdepress the medullary cough center (dextromethorphanandcodeine) or anesthetize stretch receptors of vagal afferent fibers in bronchi and alveoli (benzonatate).Dextromethorphan, a congener of the opioidlevorphanol, is effective as a tablet or syrup.Codeinehas antitussive, analgesic, and sedative effects, but dependence is a potential problem, and nausea, vomiting, constipation, and tolerance are common adverse effects. Other opioids (hydrocodone,hydromorphone,methadone,morphine) have antitussive properties but are avoided because of high potential for dependence and abuse.Benzonatate, a congener oftetracainethat is available in liquid-filled capsules,. ), and hypertonic saline are generally reserved for hospital-based treatment of cough in patients with Bronchiectasis or Topical treatments,such as acacia, licorice,glycerin, honey, and wild cherry cough drops or syrups (demulcents), are locally and perhaps emotionally soothing, but their use is not supported by scientific evidence. Protussives,which stimulate cough, are indicated for such disorders as cystic fibrosis and bronchiectasis, in which a productive cough is thought to be important for airway clearance and preservation of pulmonary function. DNase or hypertonic saline is given in conjunction with chest physical therapy and postural drainage to promote cough and expectoration. This approach is beneficial in cystic fibrosis but not in most other causes of chronic cough. Bronchodilators,such asalbuterolandipratropiumor inhaled corticosteroids, can be effective for cough after URI and in cough-variant asthma. 1.Morice AH, Millqvist E, Bieksiene K, et al: ERS guidelines on the diagnosis and treatment of chronic cough in adults and children.Eur Respir J55(1): 1901136, 2020. doi: 10.1183/13993003.01136-2019 