APPROPRIATE USE OF ANTITUSSIVES AND PROTUSSIVES - A PRACTICAL REVIEW

As a symptom of an underlying condition, cough is one of the most comm on reasons patients see physicians. To the majority, a cough means tha t 'something is wrong' and it causes exhaustion and/or self-consciousn ess. Patients find these reasons as well as effects on lifestyle, fear of cancer and/or AIDS or tuberculosis to be the most troublesome conc erns for which they seek medical attention. The treatment of cough can be divided into two main categories: (a) therapy that controls, preve nts or eliminates cough (i.e. antitussive); and (b) therapy that makes cough more effective (i.e. protussive). Antitussive therapy can be ei ther specific or nonspecific. Definitive or specific antitussive thera py depends on determining the aetiology or operant pathophysiological mechanism, and then initiating specific treatment. Since the cause of chronic cough can almost always be determined, it is possible to presc ribe specific therapy that can be almost uniformly successful. Nonspec ific antitussive therapy is directed at the symptom; it is indicated w hen definitive therapy cannot be given. Practically speaking, the effi cacy of nonspecific therapy must be evaluated in double-blind, placebo -controlled, randomised studies of pathological cough in humans. Such studies have demonstrated the efficacy of dextromethorphan, codeine an d ipratropium bromide aerosol in patients with chronic bronchitis. Whi le the preferred treatment for patients with cough due to angiotensin converting enzyme (ACE) inhibitor therapy is withdrawal of the offendi ng drugs, it may be possible to ameliorate the cough by adding nifedip ine, sulindac or indomethacin to the treatment regimen. The efficacy o f protussive therapy has not been welt documented. Although hypertonic saline aerosol and erdosteine in patients with bronchitis, and amilor ide aerosol in patients with cystic fibrosis have been shown to improv e mucus clearance, their clinical utility has not been adequately stud ied.