Cough medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], M.Umer Tariq [3] Abiodun Akanmode,M.D.[4]


A systematic approach to evaluation and diagnosis is the standard when managing cough.

Medical Therapy

Cough syrups

Coughs can be treated with cough medicines. Dry coughs are treated with cough suppressants (antitussives) that suppress the body's urge to cough. In contrast, productive coughs (coughs that produce phlegm) are treated with expectorants that loosen mucus from the respiratory tract. Centrally acting cough suppressants, such as codeine and dextromethorphan reduce the urge to cough by inhibiting the response of the sensory endings by depolarization of the vagus nerve. A recent study indicates that, because of the presence of theobromine in chocolate, 50 grams of dark chocolate may be an effective treatment for a persistent cough.


Antibiotics should only be utilized in the cough management algorithm when an infectious etiology is suspected. Appropriate antibiotics are selected after sputum culture and pathogen sensitivity. Amoxicillin/clavulanate is usually the first-line antibiotics in most cases. However, alternative therapies include the following:

Chronic cough

When managing patients with chronic cough attempt should be made to identify the underlying etiology of the cough and symptomatic relief treatment should be avoided. The use of antitussives agents, such as codeine and dextromethorphan, have been shown to have decreased or no advantage in the treatment of chronic cough and any beneficial effect is largely due to placebo effect.[1][2]For patients with GERD dietary modifications including avoiding chocolate,alcohol,caffeine and smoking, should be encouraged in addition to medical therapy with PPI.Smokers should quit smoking and patients on medications such as ACEIS should be stopped or switched with alternatives.[3][4]


  1. Chung KF (2007). "Chronic cough: future directions in chronic cough: mechanisms and antitussives". Chron Respir Dis. 4 (3): 159–65. doi:10.1177/1479972307077894. PMID 17711916 PMID: 17711916 Check |pmid= value (help).
  2. Zanasi A, Lanata L, Fontana G, Saibene F, Dicpinigaitis P, De Blasio F (2015). "Levodropropizine for treating cough in adult and children: a meta-analysis of published studies". Multidiscip Respir Med. 10 (1): 19. doi:10.1186/s40248-015-0014-3. PMC 4472410. PMID 26097707 PMID: 26097707 Check |pmid= value (help).
  3. Kahrilas PJ, Altman KW, Chang AB, Field SK, Harding SM, Lane AP; et al. (2016). "Chronic Cough Due to Gastroesophageal Reflux in Adults: CHEST Guideline and Expert Panel Report". Chest. 150 (6): 1341–1360. doi:10.1016/j.chest.2016.08.1458. PMC 6026249. PMID 27614002 PMID: 27614002 Check |pmid= value (help).
  4. Randel A (2016). "ACCP Releases Guideline for the Treatment of Unexplained Chronic Cough". Am Fam Physician. 93 (11): 950. PMID 27281841 PMID: 27281841 Check |pmid= value (help).

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