Cough management: a practical approach

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• A concept that is worth highlighting is the importance of treating cough to avoid the development of persistent cough.

• Treatment

• Central Antitussives

• Peripheral Antitussive

• Acute and sub acute cough

• The Food and Drug Administration (FDA) issued a warning for parents and health workers against the use of OTC products for cough and common colds in infants and children under 2 years of age because of serious side effects and the potential danger to life that may arise as a result of their use in children

• As far as the level of benefit is concerned, the effects of peripherally acting anti-tussives, such as levodropropizine and moguisteine, compare favorably with centrally-acting drugs, based on the evidence from clinical trials and according to the available clinical practice guidelines

• peripheral anti-tussive drugs have been recommended for the treatment of acute and sub-acute cough, both in children and adults

• However, under certain circumstances, the cause of cough is not treatable, even if it is known (e.g., endobronchial lung cancer or pulmonary fibrosis)

• In such situations, a non-specific (symptomatic) anti-cough therapy for symptomatic relief seems appropriate

• limited efficacy, intolerable side effects, or both

• guidelines for chronic cough from both the U.S., and Europe, recommend the empiric use of inhaled corticosteroids for adult patients when treating cough due to asthma

• proton pump inhibitors when the cough is associated with GERD

• and first-generation anti-histamines when it is subsequent to an the upper airway syndrome

• The American College of Chest Physicians (ACCP) issued their evidence based "Guidelines on Cough" in 2006

• which state that anti-tussive drugs related with therapy of acute or chronic bronchitis showing the highest level of benefit were levodropropizine and moguisteine, that act through a peripheral mechanism, while the central antitussive drugs such as codeine and dextromethorphan showed a lower level of benefit.