The coughing is one of the most common symptoms that plague and often lead a patient to the pharmacy (mostly) or to a doctor (less often). Most coughing episodes are transient, meaning they will last for a short time and then subside. However, coughing of prolonged duration may lead to the use of an approved medicine to treat it. The most commonly prescribed medications to treat coughs act either on the brain centre responsible for coughing [e.g. dextromethorphan, butamirate (Sinecod), pentoxyvirine (Tuclase) and codeine (Sival-B)], or peripherally in the lungs [e.g. levodroprazine (Levotuss)], or they work by facilitating the liquefaction of bronchial secretions, [apochreptics e.g. acetylcysteine (Trebon-N), ambroxol (Mucosolvan), bromhexine (Bisolvon), carbocysteine (Mucothiol)]. Although these agents are commonly recommended, data on their effectiveness come from small studies with weak methodologies conducted many years ago. Moreover, most of the studies that have seen the light of day have conflicting results.
Studies involving the use of dextromethorphan in children have shown no clinically significant difference in cough symptoms compared to placebo. This lack of effect is not affected by dose, as demonstrated by studies of higher doses of dextromethorphan. In adult patients with upper respiratory infection also no additional benefit has been found from the use of dextromethorphan or codeine. An earlier study concluded that dextromethorphan may be a better alternative to codeine. The same applies to the other antitussive with centralised action. Unlike dextromethorphan, there is some evidence to suggest that expectorants may reduce the amount and thickness of sputum. Their efficacy in terms of assisting in the remission of the main disease (e.g. chronic lung disease, pneumonia) is strongly questioned.
Popular non-pharmacological approaches include vapour generation (e.g. menthol) and the honey. Menthol is a mild anaesthetic that provides a cooling sensation when used as cough drops. Recent studies have focused on patients who inhale evaporated menthol solutions showing that inhaling menthol can reduce coughing. In contrast, commonly used menthol products in lozenge, ointment or cream form have not been studied. Honey can soothe a cough. Randomised controlled trials found that honey was more effective than placebo in reducing cough symptoms. Currently, the evidence for or against the use of honey for patients with cough is also limited. Honey or any honey-containing products are not recommended for infants younger than 1 year of age because there is a higher risk of botulism in this population. Other non-pharmacological suggestions for cough control include hydration and the use of humidifiers.
In conclusion, data on the effectiveness of cough suppressants in reducing the frequency or duration of cough are lacking. It is therefore important to inform patients that most cough episodes will resolve in a week or two. Cough that includes thick yellow or green phlegm or blood, involuntary weight loss, fever >38°C, night sweats, or when severe underlying medical conditions co-exist (e.g. chronic obstructive pulmonary disease, heart or renal failure, immunosuppression), or o cough that lasts longer or worsens after 7 days of treatment, should seek medical attention.
Source: www.medscape.org
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