Cough management: a practical approach

In addition to being an airway defence mechanism, coughing is a very common symptom observed in many diseases other than those affecting the respiratory system. To recognize its cause is not always an easy task. Where possible, the clinician should avoid treatment based on symptoms only which often only serves the purpose to reassure the patient or the parents (in the case of a paediatric patient). On the other hand it is worth mentioning that internal medicine physicians are frequently overwhelmed by requests for help by patients who report coughing, alone or together with other non-specific symptoms such as malaise, pharyngodynia, and a mild temperature. In such cases, treatment of symptoms alone appears justified as a therapeutic approach. However, it must be emphasized that a high level of suspicion needs to be maintained, especially when coughing persists which would require a thorough investigation of other possible causes.This review summarises the effectiveness of symptomatic cough remedies including two specific drugs (levodropropizine and moguisteine) which have been tested in the symptomatic treatment of cough, and have received Grade A evidence in the treatment of cough due to either acute or chronic bronchitis. In addition we identify missing pieces of evidence regarding the efficacy of symptomatic cough treatments as well as associated side effects. Moreover, clear treatment algorhythms still need to be established for acute and chronic coughA thorough systematic literature search was conducted in the main international search databases (Pubmed, Embase, Biosis) of all articles (both original clinical trials and reviews) published in the period from 1950 up to now. For this search, all keywords related to cough (acute, sub acute and chronic), cough mechanism and pathogenesis, cough treatment (cough suppressants, anti-tussives and other drugs with anti-tussive activity) were used.Authors' recommendations were based on this clinical evidence and on availa