From the Guidelines
Elderly patients with cough due to chronic bronchitis should be treated with ipratropium bromide or peripheral cough suppressants like levodropropizine and moguisteine for short-term symptomatic relief, as recommended by the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines 1. When considering cough medicine in elderly patients, it is essential to prioritize their safety and potential drug interactions.
- For elderly individuals with cough due to chronic bronchitis, ipratropium bromide is recommended as the only inhaled anticholinergic agent for cough suppression, with a substantial benefit and an A grade of recommendation 1.
- Peripheral cough suppressants, such as levodropropizine and moguisteine, are also recommended for short-term symptomatic relief of coughing in patients with chronic or acute bronchitis, with a substantial benefit and an A grade of recommendation 1.
- Central cough suppressants, such as codeine and dextromethorphan, may be considered for short-term symptomatic relief of coughing in patients with chronic bronchitis, but with a lower grade of recommendation (B) and intermediate benefit 1.
- It is crucial to avoid combination products containing antihistamines or decongestants, as they can cause confusion, urinary retention, dry mouth, and cardiovascular effects in elderly patients.
- Non-pharmacological approaches, such as staying hydrated, using humidifiers, and honey-lemon tea for soothing irritation, are often preferable and should be encouraged.
- Any cough persisting beyond 2 weeks requires medical evaluation, as it may indicate a more serious condition, and elderly patients should always check with their healthcare provider before taking cough medicines, especially if they have chronic conditions or take other medications that might interact with cough remedies.
From the Research
Causes of Cough in the Elderly
- Respiratory tract infections in the nose, larynx, and/or bronchi are the most common cause of acute cough in the elderly, with both viral and bacterial infections being frequent and hazardous 2
- Specific viruses and bacteria that have been identified as causes of acute cough in the elderly include:
- Rhinovirus
- Influenza
- Respiratory syncytial viruses
- Streptococcus pneumoniae
- Haemophilus influenza
- Bordetella pertussis
Diagnosis and Treatment of Cough in the Elderly
- Successful diagnosis is crucial for successful treatment, and should involve clinical examination, patient history, and supplemental tests such as chest X-ray, viral and bacterial culture, and serological testing 2
- Depending on the results of these tests, specific antibacterial therapy may be necessary, although there is some debate about the use of antibacterial therapy in cases where the diagnosis is uncertain 2
- Non-specific antitussive therapy is commonly used to prevent the adverse effects of repeated coughing, with opioids and dextromethorphan being the most commonly used agents 2