Cough management: a practical approach

Springer Science and Business Media LLC - 2011
Francesco De Blasio1, J. Christian Virchow2, Mario Polverino3, Alessandro Zanasi4, Panagiotis Behrakis5, Gunsely Kilinç6, Rossella Balsamo7, G Danieli7, Luigi Lanata7
1Department of Respiratory Medicine and Pulmonary Rehabilitation, Clinic Center, Private Hospital, Naples, Italy
2Department of Pneumology and Intensive Care Medicine, University of Rostock, Germany
3Department of Medicine and Medical Specialities, Azienda Sanitaria Locale (ASL) Salerno, Italy
4Centre for Study and Treatment of Cough Respiratory Medicine, S. Orsola, Malpighi Hospital Bologna, Italy
5Department of Experimental Physiology, University of Athens, Greece
6Department of Chest Disease, Cerrahpasa Faculty of Medicine, University of Istanbul, Turkey
7Medical Department, Dompé S.P.A, via San Martino 12, Milan, Italy

Tóm tắt

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.

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Tài liệu tham khảo

Eccles R: Acute cough: epidemiology, mechanisms and treatment. Acute and chronic cough. Lung biology in health and disease. Redington A, Morice A (eds). 2005, 205: 215-236.

Pratter MR: Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129S: 59S-62S.

Morice AH, McGarvey L, Pavord I: British Thoracic Society Cough Guideline Group: Recommendations for the management of cough in adults. Thorax. 2006, 61 (Suppl 1): i1-24.

Pratter MR, Brightlin CE, Boulet LP, Irwin RS: An empiric integrative approach to the management of cough. Chest. 2006, 129: 222S-231S. 10.1378/chest.129.1_suppl.222S.

Harnden A, Grant C, Harrison T, Perera R, Brueggemann AB, Mayon-White R, Mant D: Whooping cough in school age children with persistent cough: prospective cohort study in primary care. BMJ. 2006, 333: 174-177. 10.1136/bmj.38870.655405.AE.

Cerveri I, Accordini S, Corsico A, Zoia MC, Carrozzi L, Cazzoletti L, Beccaria M, Marinoni A, Viegi G, de Marco R, ISAYA Study Group: Chronic cough and phlegm in young adults. Eur Respir J. 2003, 22: 413-417. 10.1183/09031936.03.00121103.

Zemp E, Elsasser S, Schindler C, Künzli N, Perruchoud AP, Domenighetti G, Medici T, Ackermann-Liebrich U, Leuenberger P, Monn C, Bolognini G, Bongard JP, Brändli O, Karrer W, Keller R, Schöni MH, Tschopp JM, Villiger B, Zellweger JP: Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). The SAPALDIA Team. Am J Respir Crit Care Med. 1999, 159: 1257-1266.

Irwin RS, Ownbey R, Cagle PT, Baker S, Fraire AE: Interpreting the histopathology of chronic cough: a prospective, controlled, comparative study. Chest. 2006, 130: 362-370. 10.1378/chest.130.2.362.

Chung KF, Pavord ID: Prevalence, pathogenesis, and cause of chronic cough. Lancet. 2008, 371: 1364-1374. 10.1016/S0140-6736(08)60595-4.

Irwin RS, Curley FJ, French CL: Chronic cough: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis. 1990, 141: 640-647. 10.1164/ajrccm/141.3.640.

Irwin RS, Corrao WM, Pratter MR: Chronic persistent cough in the adult. The spectrum and frequency of causes and successful outcome of specific therapy: Am Rev Respir Dis. 1981, 123: 413-417.

Pratter MR, Bartter T, Akers S, DuBois J: An algorithmic approach to chronic cough. Ann Intern Med. 1993, 119: 977-983.

Poe RH, Harder RV, Israel RH, Kallay MC: Chronic persistent cough: experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest. 1989, 95: 723-728. 10.1378/chest.95.4.723.

Mello CJ, Irwin RS, Curley FJ: Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med. 1996, 156: 997-1003. 10.1001/archinte.156.9.997.

Palombini BC, Villanova CA, Araújo E, Gastal OL, Alt DC, Stolz DP, Palombini CO: A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest. 1999, 116: 279-284. 10.1378/chest.116.2.279.

Smyrnios NA, Irwin RS, Curley FJ: Chronic cough with a history of excessive sputum production: the spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Chest. 1995, 108: 991-997. 10.1378/chest.108.4.991.

Corrao WM, Braman SS, Irwin RS: Chronic cough as the sole presenting manifestation of bronchial asthma. N Engl J Med. 1979, 300: 633-637. 10.1056/NEJM197903223001201.

Irwin RS, Zawacki JK, Curley FJ, French CL, Hoffman PJ: Chronic cough as the sole presenting manifestation of gastroesophageal reflux. Am Rev Respir Dis. 1989, 140: 1294-1300. 10.1164/ajrccm/140.5.1294.

Gibson PG, Dolovich J, Denburg J, Ramsdale EH, Hargreave FE: Chronic cough: eosinophilic bronchitis without asthma. Lancet. 1989, 1: 1346-1348.

Gibson PG, Hargreave FE, Girgis-Gabardo : Chronic cough with eosinophilic bronchitis: examination for variable airflow obstruction and response to corticosteroid. Clin Exp Allergy. 1995, 25: 127-132. 10.1111/j.1365-2222.1995.tb01017.x.

Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID: Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med. 1999, 160: 406-410.

Ayik SO, Başoğlu OK, Erdínç M, Bor S, Veral A, Bílgen C: Eosinophilic bronchitis as a cause of chronic cough. Respir Med. 2003, 97: 695-701. 10.1053/rmed.2003.1503.

Puolijoki H, Lahdensuo A: Causes of prolonged cough in patients referred to a chest clinic. Ann Med. 1989, 21: 425-427. 10.3109/07853898909149233.

McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M, Shepherd DR, MacMahon J: Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax. 1998, 53: 738-743. 10.1136/thx.53.9.738.

O'Connell F, Thomas VE, Pride NB, Fuller RW: Capsaicin cough sensitivity decreases with successful treatment of chronic cough. Am J Respir Crit Care Med. 1994, 150: 374-380.

Chung KF: Currently available cough suppressants for chronic cough. Lung. 2008, 186: S82-S87. 10.1007/s00408-007-9030-1.

Bolser DC: Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129: 238S-249S. 10.1378/chest.129.1_suppl.238S.

Freestone C, Eccles R: Assessment of the antitussive efficacy of codeine in cough associated with common cold. J Pharm Pharmacol. 1997, 49: 1045-1049.

Smith SM, Schroeder K, Fahey T: Over-the-counter medications for acute cough in children and adults in ambulatory settings. Cochrane Database Syst Rev. 2008, 23: CD001831-

FDA Releases Recommendations Regarding Use of Over-the-Counter Cough and Cold Products. [http://www.fda.gov/bbs/topics/NEWS/2008/NEW01778.html]

Robinson RE, Cummings WB, Deffenbaugh ER: Effectiveness of guaifenesin as an expectorant: a cooperative double-blind study. Current Therapeutic Research. 1977, 22: 284-296.

Berkowitz RB, Tinkelman DG: Evaluation of oral terfenadine for treatment of the common cold. Ann Allergy. 1991, 67: 593-597.

Curley FJ, Irwin RS, Pratter MR, Stivers DH, Doern GV, Vernaglia PA, Larkin AB, Baker SP: Cough and the common cold. Am Rev Respir Dis. 1988, 138: 305-311.

Kurth W: Secure therapeutic effectiveness of the traditional antitussive agent Mintetten in a double-blind study. Köln Med Welt. 1978, 29: 1906-1909. German

Thackray P: A double-blind, crossover controlled evaluation of a syrup for the night-time relief of the symptoms of the common cold, containing paracetamol, dextromethorphan hydrobromide, doxylamine succinate and ephedrine sulphate. J Int Med Res. 1978, 6: 161-165.

Tukiainen H, Karttunen P, Silvasti M, Flygare U, Korhonen R, Korhonen T, Majander R, Seuri M: The treatment of acute transient cough: a placebo-controlled comparison of dextromethorphan and dextromethorphan-beta 2-sympathomimetic combination. Eur J Respir Dis. 1986, 69: 95-99.

Gaffey MJ, Kaiser DL, Hayden FG: Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator of common cold symptoms. Pediatr Infect Dis J. 1988, 7: 223-228. 10.1097/00006454-198803000-00032.

Clinical trials of antihistaminic drugs in the prevention and treatment of the common cold; report by a special committee of the Medical Research Council. Br Med J. 1950, 2: 425-429.

Korppi M, Laurikainen K, Pietikäinen M, Silvasti M: Antitussives in the treatment of acute transient cough in children. Acta Paediatr Scand. 1991, 80: 969-971. 10.1111/j.1651-2227.1991.tb11764.x.

Taylor JA, Novack AH, Almquist JR, Rogers JE: Efficacy of cough suppressants in children. J Pediatr. 1993, 122: 799-802. 10.1016/S0022-3476(06)80031-4.

Sakchainanont B, Ruangkanchanasetr S, Chantarojanasiri T, Tapasart C, Suwanjutha SJ: Effectiveness of antihistamines in common cold. Med Assoc Thai. 1990, 73: 96-101.

Paul IM, Yoder KE, Crowell KR, Shaffer ML, McMillan HS, Carlson LC, Dilworth DA, Berlin CM: Effect of dextromethorphan, diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004, 114: e85-90. 10.1542/peds.114.1.e85.

Clemens CJ, Taylor JA, Almquist JR, Quinn HC, Mehta A, Naylor GS: Is an antihistamine-decongestant combination effective in temporarily relieving symptoms of the common cold in preschool children?. J Pediatr. 1997, 130: 463-466. 10.1016/S0022-3476(97)70211-7.

Hutton N, Wilson MH, Mellits ED, Baumgardner R, Wissow LS, Bonuccelli C, Holtzman NA, DeAngelis C: Effectiveness of an antihistamine-decongestant combination for young children with the common cold: a randomized, controlled clinical trial. J Pediatr. 1991, 118: 125-130. 10.1016/S0022-3476(05)81865-7.

Matthys H, Bleicher B, Bleicher U: Dextromethorphan and codeine: objective assessment of antitussive activity in patients with chronic cough. J Int Med Res. 1983, 11: 92-100.

Current and future peripherally-acting antitussives. P.V. Dicpinigitis Respiratory and Physiology & Neurobiology. 2006, 152 (3):

Allegra L, Bossi R: Clinical trials with the new antitussive levodropropizine in adult bronchitic patients. Arzneimittelforschung. 1988, 38: 1163-1166.

Catena E, Daffonchio L: Efficacy and tolerability of levodropropizine in adult patients with non-productive cough. Comparison with dextromethorphan. Pulm Pharmacol Ther. 1997, 10: 89-96.

Luporini G, Barni S, Marchi E, Daffonchio L: Efficacy and safety of levodropropizine and dihydrocodeine on nonproductive cough in primary and metastatic lung cancer. Eur Respir J. 1998, 12: 97-101. 10.1183/09031936.98.12010097.

Gunella G, Zanasi A, Massimo Vanasia CB: Efficacy and safety of the use of levodropropizine in patients with chronic interstitial lung diseases. Clin Ter. 1991, 136: 261-266. Italian

Tamburrano D, Romandini S: Multicentric study on tolerability and efficacy of Levodropropizine, a new antitussive drug, in a wide pediatric study group. Terapie Essenziali in Clinica. 1989, 4-89: 3-7. Italian

Cogo R, Tamburrano D, Romandini S, Rugarli PL: Multincentric Study on Efficacy and Tolerability of Levodropropizine: a new antitussive drug. Farmaci. 1989, 3: 8-13. Italian

Fiocchi A, Zuccotti GV, Vignati B, Pogliani L, Sala M, Riva E: Evaluation of the treatment with levodropropizine of respiratory diseases in children. Pediatr Med Chir. 1989, 11: 519-522. Italian

Banderali G, Riva E, Fiocchi A, Cordaro CI, Giovannini M: Efficacy and tolerability of levodropropizine and dropropizine in children with non-productive cough. J Int Med Res. 1995, 23: 175-183.

Kim DS, Sohn MH, Jang GC: Levodropropizine in Children with Bronchitis. Diagnosis and Treatment. 2002, 22 (9): Korean-

Chung KF: Effective antitussives for the cough patient: an unmet need. Pulm Pharmacol Ther. 2007, 20: 438-445. 10.1016/j.pupt.2006.10.015.

Woo T: Pharmacology of cough and cold medicines. J Pediatr Health Care. 2008, 22: 73-79. 10.1016/j.pedhc.2007.12.007. quiz 80-82

Pavesi L, Subburaj S, Porter-Shaw K: Application and validation of a computerized cough acquisition system for objective monitoring of acute cough: a meta-analysis. Chest. 2001, 120: 1121-1128. 10.1378/chest.120.4.1121.

Sharfstein JM, North M, Serwint JR: Over the counter but no longer under the radar--pediatric cough and cold medications. N Engl J Med. 2007, 357: 2321-2324. 10.1056/NEJMp0707400.

American Academy of Pediatrics. Committee on Drugs: Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997, 99: 918-920.

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UB, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Smith Hammond C, Tarlo SM, American College of Chest Physicians (ACCP): Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest. 2006, 129: 1S-23S. 10.1378/chest.129.1_suppl.1S.

Rutgers SR, Timens W, Kaufmann HF, van der Mark TW, Koëter GH, Postma DS: Comparison of induced sputum with bronchial wash, bronchoalveolar lavage and bronchial biopsies in COPD. Eur Respir J. 2000, 15: 109-115. 10.1183/09031936.00.15110900.

Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, O'Connell F, Geppetti P, Gronke L, De Jongste J, Belvisi M, Dicpinigaitis P, Fischer A, McGarvey L:

Fokkens WJ, Kastelik J, ERS Task Force: The diagnosis and management of chronic cough. Eur Respir J. 2004, 24: 481-492. 10.1183/09031936.04.00027804.

Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM: Cough in children: definitions and clinical evaluation. Med J Aust. 2006, 184: 398-403.

Chang AB, Lasserson TJ, Kiljander TO, Connor FL, Gaffney JT, Garske LA: Systematic review and meta-analysis of randomised controlled trials of gastro-oesophageal reflux interventions for chronic cough associated with gastro-oesophageal reflux. BMJ. 2006, 332: 11-17. 10.1136/bmj.38677.559005.55.

Tomerak AA, McGlashan JJ, Vyas HH, McKean MC: Inhaled corticosteroids for non-specific chronic cough in children. Cochrane Database Syst Rev. 2005, 4: CD004231-

Macdessi JS, Randell TL, Donaghue KC, Ambler GR, van Asperen PP, Mellis CM: Adrenal crises in children treated with high-dose inhaled corticosteroids for asthma. Med J Aust. 2003, 178: 214-216.

Mortimer KJ, Tata LJ, Smith CJ, West J, Harrison TW, Tattersfield AE, Hubbard RB: Oral and inhaled corticosteroids and adrenal insufficiency: a case-control study. Thorax. 2006, 61: 405-408. 10.1136/thx.2005.052456.

Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB: Evaluation and outcome of young children with chronic cough. Chest. 2006, 129: 1132-1141. 10.1378/chest.129.5.1132.

Pratter MR: Chronic upper airway cough syndrome secondary to Rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest. 2006, 129: 63S-67S. 10.1378/chest.129.1_suppl.63S.

Chang AB, Peake J, McElrea M: Anti-histamines for prolonged non-specific cough in children. Cochrane Database Syst Rev. 2008, 2: CD005604-

Pratter MR: Cough and the common cold. Chest. 2006, 129: 72S-74S. 10.1378/chest.129.1_suppl.72S.

Silvestri RC, Weinberger SE: Evaluation of sub acute and chronic cough in adults. 2010, UpToDate.com

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