From the Guidelines
The most effective treatments for a persistent cough are gabapentin, multimodality speech pathology therapy, and inhaled corticosteroids in specific cases.
Treatment Options
- Gabapentin: A therapeutic trial of gabapentin is suggested for adult patients with unexplained chronic cough, with a dose escalation schedule beginning at 300 mg once a day, up to a maximum tolerable daily dose of 1,800 mg a day in two divided doses 1.
- Multimodality speech pathology therapy: This therapy is suggested for adult patients with unexplained chronic cough, as it has been associated with improvement in quality of life 1.
- Inhaled corticosteroids: These are suggested for adult patients with chronic cough and positive tests for bronchial hyperresponsiveness and eosinophilia, but not for those with negative tests 1.
Additional Considerations
- Cough suppressants: Central cough suppressants such as codeine and dextromethorphan are recommended for short-term symptomatic relief of coughing in patients with chronic bronchitis and lung cancer 1.
- Avoidance of irritants: Avoidance of respiratory irritants, such as personal tobacco use and passive smoke exposure, is the most effective way to reduce or eliminate cough in patients with chronic bronchitis 1.
- Pharmacologic therapy: Pharmacologic therapy, such as bronchodilators and corticosteroids, may provide relief from cough in patients with comorbid diseases, such as chronic bronchitis and asthma, but its effectiveness in patients with lung cancer is variable 1.
From the Research
Treatment Options for Persistent Cough
- The current treatments for chronic cough have minimal efficacy, and there are no FDA-approved pharmacologic treatments available 2.
- Historical treatments such as opiates and neuromodulators have been used with limited success 2, 3.
- Emerging agents that target specific channel receptors have shown initial positive benefits concerning cough frequency, severity, and quality of life 2.
- Treatment of the underlying cause of the cough is essential, and specific treatment should control the cough, but this may not occur in all cases 3, 4.
- Symptomatic relief must be considered when the cough interferes with the patient's daily activities, and antitussive preparations are available for effective symptomatic relief of dry or non-productive cough 3, 4.
Pharmacologic Treatments
- Antitussives such as codeine or dextromethorphan with antihistamines, decongestants, and expectorants are used for effective symptomatic relief of dry or non-productive cough 4.
- First-generation antihistamines like chlorpheniramine and centrally acting opioid derivatives like codeine are often used alone or in combination in the management of nonspecific cough 4.
- Low-dose morphine is highly effective in a subset of patients with cough resistant to other treatments 5.
- Gabapentin and pregabalin are also advocated, but in clinical experience, they are limited by adverse events 5.
Non-Pharmacologic Treatments
- Cough suppression therapy when performed by competent practitioners can be highly effective 5.
- A pediatric-specific algorithm should be used for children, and a pursuit of an underlying cause for cough is advocated 5.
- Antibiotics can be curative for persistent bacterial bronchitis, a common cause of wet cough in children 5.