The investigation and management of cough in adults

Abstract

Cough is the most common reason why patients consult their doctor. An acute cough due to viral upper respiratory tract infection is disruptive to the individual and can lead to a reduction in productivity. Dextromethorphan is one of the most widely used antitussives; however, there is a paucity of evidence to support the use of antitussive medications. In some patients, the cough persists and impacts on health-related quality of life. Cough hypersensitivity syndrome (CHS) is an emerging term for patients with a chronic cough and it recognizes cough reflex hypersensitivity as a key feature. Most patients describe a laryngeal irritation, such as a tickle sensation, also known as laryngeal paraesthesia. The initial management of CHS is to minimize common aggravators, such as airway inflammation, gastro-oesophageal reflux and rhinitis, which may exacerbate a cough. In cases of refractory cough, speech- or physiotherapy-led cough suppression therapies and gabapentin are recommended. There is a pressing need to develop effective antitussive medications that target peripheral and central cough neural pathways.