DRUGS FOR COUGH

Dr.Vijay Bhushanam
Cough (Introduction)

Cough is an explosive expiration, that provides a normal

protective mechanism for clearing the tracheo-bronchial
tree of secretions and foreign material.

When excessive or bothersome, it is also one of the most

common symptoms for which patients seek medical
attention.

Reasons for this include discomfort from the cough itself,

interference with normal lifestyle, and concern for the
cause of the cough, especially fear of cancer.
Mechanism of cough

Coughing may be initiated either voluntarily or reflexively.

As a defensive reflex it has both afferent and efferent

pathways.

The afferent limb includes receptors within the sensory

distribution of the trigeminal, glossopharyngeal, superior
laryngeal and vagus nerves.

The efferent limb includes the recurrent laryngeal nerve

and the spinal nerves.
Mechanism of cough (Cont.)

Deep inspiration glottic closure relaxation of the

diaphragm muscle contraction against a closed glottis
markedly positive intrathoracic pressure narrowing
of the trachea glottis opens at once the large
pressure differential between the airways and the
atmosphere coupled with tracheal narrowing produces
rapid flow rates through the trachea COUGH

The shearing forces that develop aid in the elimination of

mucus and foreign materials.
Etiology of Cough

The most common causes of cough can be categorized

according to the duration of the cough.
Acute cough (<3 weeks): URTIs (especially the common
cold, acute bacterial sinusitis, and pertussis), pneumonia,
pulmonary embolus, and congestive heart failure.
Sub-acute cough (3-8 weeks): post-infectious
Chronic cough (>8 weeks):
In a smoker: chronic obstructive lung disease or
bronchogenic carcinoma.
In a nonsmoker: postnasal drip (sometimes
termed the upper airway cough syndrome), asthma, and
gastroesophageal reflux.
Types of Cough

Non-productive (dry): No useful purpose, increases

discomfort to the patient needs suppression

Productive (tenacious): Presence of excessive

sputum suppression not desired needs
coughing/clearing out of the sputum
Classification of drugs for Cough

Pharyngeal demulcents: Lozenges, cough drops, linctuses

containing syrup, Glycerine, Liquorice
Expectorants:
1. Mucokinetics (Bronchial secretion enhancers): Sodium or
potassium citrate, Potassium iodide, Guaphenisin (Glyeryl
guaiacolate), balsum of Tolu, Vasaka, Ammonium chloride.
2. Mucolytics: Bromhexene, Ambroxol, Acetylcystein,
Carbocystein
Antitussives (Cough center supressants):
a) Opioids: Codein, Pholcodein
b) Non-opioids: Noscapine, Dextromethorphan, Chlophedianol
c) Antihistaminics:Chlorpheniramine, Diphenhydramine,
Promethazine
Adjuvant antitussives:
Bronchodilators: Salbutamol, Terbutaline
Pharyngeal demulcents

Sooth the throat and reduce afferent impulses from the

inflamed/irritated pharyngeal mucosa.

E.g: Lozenges, cough drops, linctuses containing syrup,

Glycerine, Liquorice
Expectorants

Increase bronchial secretions or reduce its viscosity,

facilitating its removal by coughing

E.g:
Mucokinetics (Bronchial secretion enhancers): Sodium or
potassium citrate, Potassium iodide, Guaphenisin (Glyeryl
guaiacolate), balsum of Tolu, Vasaka, Ammonium
chloride.

Mucolytics: Bromhexene, Ambroxol, Acetylcystein,

Carbocystein
Antitussives
(Cough center supressants)
These act
in CNS to raise the threshold of cough center (and/or)
peripherally in Respiratory tract to reduce tussal impulse
Should be used only for dry unproductive cough (or)
if the cough is unduly tiring, disturbs sleep (or)
is hazardous (hernia, piles, cardiac ds., ocular surgery etc)
E.g:
Opioids: Codein, Pholcodein
Non-opioids: Noscapine, Dextromethorphan,
Chlophedianol
Antihistaminics: Chlorpheniramine, Diphenhydramine,
Promethazine
Bronchodilators

Bronchospasm can induce/aggravate cough, especially

in individuals with bronchial hyperreactivity
Bronchodilators relieve cough in such individuals
Improve the effectiveness of cough in clearing
secretions by increasing the surface velocity of airflow
during cough

E.g: Salbutamol, Terbutalin

Antitussive/Expectorant
Combinations

AMBRODYL PLUS: Ambroxol, Chlorpheniramine,

Salbutamol, Guaphenesin.
ASTHALIN: Salbutamol, Guaphenesin.
ASCORIL-C: Codeine, Chlorpheniramine.
BENADRYL: Diphenhydramine, Ammonium chloride,
Sodium citrate, Menthol.
GRILINCTUS: Dextromethorphan, Chlorpheniramine,
Guaphenesin, ammonium chloride.
Specific Rx for cough

URTI/LRTI Appropriate antibiotics

Smoking/Chr. Bronchitis Cessation of smoking/
avoidance of pollutants
PTB ATT
Post nasal drip due to sinusitis Antibiotics/Nasal
decongestants/H1 antihistaminics
Postnasal drip due to allergy Avoidance of precipitating
factors/Corticosteroid nasal spray/H1 antihistaminics
GERD H2 blockers/PPIs/Cisapride
ACE inhibitor induced cough Switch to ARBs/CCBs
Asthmatic cough Inhaled 2
agonists/Ipratropium/Corticosteroids
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