From the Guidelines
Central cough suppressants, such as codeine and dextromethorphan, are recommended for the short-term symptomatic relief of coughing in patients with COPD exacerbation.
Key Points
- In patients with chronic bronchitis, which is often a component of COPD, central cough suppressants are recommended for short-term symptomatic relief of coughing 1.
- Ipratropium bromide, an inhaled anticholinergic agent, is also recommended for cough suppression in patients with cough due to URI or chronic bronchitis 1.
- Peripheral cough suppressants, such as levodropropizine and moguisteine, are recommended for the short-term symptomatic relief of coughing in patients with chronic or acute bronchitis 1.
- The use of cough suppressants should be guided by the physician's specific knowledge of the disorder that is eliciting cough 1.
Medications to Avoid
- Agents that alter mucus characteristics are not recommended for cough suppression in patients with chronic bronchitis 1.
- Over-the-counter combination cold medications are not recommended until randomized controlled trials prove they are effective cough suppressants 1.
From the Research
Cough Suppressants for COPD Exacerbation
- The efficacy of cough suppressants in patients with Chronic Obstructive Pulmonary Disease (COPD) exacerbation is a topic of interest, with various studies investigating their effects 2, 3, 4.
- Currently available cough suppressants include centrally acting opioids such as morphine, codeine, and dextromethorphan, as well as peripherally acting antitussives like moguisteine and levodropropizine 2, 3.
- However, the use of codeine in COPD patients has been shown to have no significant effect on cough frequency compared to placebo in some studies 4.
- Other studies suggest that slow-release morphine may be useful in controlling intractable cough in COPD patients, but its use should be reserved for severe cases 2, 3.
- The management of COPD exacerbation typically involves targeted oxygen therapy, inhaled short-acting bronchodilators, and noninvasive ventilation, but the role of cough suppressants in this context is not well established 5.
- Inhaled therapies such as long-acting antimuscarinic (LAMA), long-acting beta2-agonist (LABA)/LAMA, inhaled corticosteroids (ICS)/LABA, and ICS/LABA/LAMA may be effective in improving cough symptoms in COPD patients, but more research is needed to determine their optimal use 6.
Safety Considerations
- The use of cough suppressants in COPD patients should be approached with caution, as high doses can be associated with side effects such as constipation, drowsiness, and respiratory depression 2, 3.
- The selection of a cough suppressant should be based on the individual patient's needs and medical history, with careful consideration of potential interactions with other medications and underlying health conditions.
- Further research is needed to determine the safety and efficacy of cough suppressants in COPD patients, particularly in the context of exacerbations 2, 3, 4.