Pharmacologic therapy for cough

Cough is the commonest symptom for which patients seek medical care and yet effective, well-tolerated cough medicines remain a significant unmet clinical need. The development of anti-tussive agents has probably been restricted by a number of factors; our understanding of the specific mechanisms evoking cough in different diseases and how this differs from the role of cough as a protective reflex is limited. Also well-validated tools for the assessment of cough have been lacking. These issues have not encouraged investment by the pharmaceutical industry and there have been no new licensed treatments for cough in more than 50 years. This article will use a mechanism-based approach to discuss the clinical evidence for the anti-tussive activity of currently available agents.

► Effective, well-tolerated cough medicines remain a significant unmet clinical need. ► There is clinical evidence that a range of medicines have anti-tussive activity in keeping with a variety of relevant central and peripheral neuronal mechanisms. ► Increasing understanding of these mechanisms is identifying novel targets with the potential to deliver efficacious medicines for cough in the future.