Treatment of cough
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Diagnosis and Identification of Underlying Causes in Cough Treatment
A systematic approach to diagnosing cough is essential, as identifying and treating the underlying cause can resolve symptoms in most cases. Common causes include respiratory, nasal, or upper gastrointestinal diseases, and addressing these can lead to successful outcomes in 84–100% of cases Irwin2000Morice2019. In children, persistent bacterial bronchitis is a frequent cause of wet cough and can often be cured with antibiotics, while in adults, cough hypersensitivity is a key concept guiding treatment .
Pharmacological Treatments for Chronic and Refractory Cough
Neuromodulators and Opioids
For chronic cough that persists after treating underlying conditions (chronic refractory cough or unexplained chronic cough), neuromodulators such as gabapentin are recommended and have shown positive effects on cough-related quality of life Visca2020Gibson2015Morice2019. Low-dose morphine can also be effective in some patients, though its use is more limited due to potential side effects Visca2020Gibson2015Morice2019. Pregabalin is another option, but adverse events may restrict its use .
P2X3 Receptor Antagonists and Emerging Therapies
Recent advances have highlighted the role of neuronal dysregulation in chronic cough, leading to the development of new pharmacological targets. P2X3 receptor antagonists, such as gefapixant, have shown promising results and represent a significant step forward in treatment options for patients with refractory or unexplained chronic cough Sykes2022Brister2023Smith2023+2 MORE. Other peripherally acting agents are also under investigation, but more studies are needed to confirm their effectiveness Sykes2022Brister2023Smith2023+1 MORE.
Other Medications
Inhaled corticosteroids and esomeprazole are not effective for unexplained chronic cough unless there are specific features such as eosinophilic bronchitis or acid reflux, respectively Gibson2015Morice2019. For non-acid reflux, promotility agents may be considered .
Non-Pharmacological Treatments for Cough
Speech Pathology and Cough Suppression Therapy
Speech pathology-based cough suppression therapy is recommended for unexplained or refractory chronic cough and has been shown to improve cough severity and quality of life Visca2020Gibson2015Morice2019. Combining speech therapy with neuromodulators may enhance treatment response and duration .
Acupuncture and Herbal Medicine
Acupuncture-related therapies, including acupuncture, acupoint herbal patching, and moxibustion, have demonstrated significant improvements in cough severity, quality of life, and overall effectiveness when used alone or alongside conventional treatments, with a low incidence of adverse events Lee2023Lee2025Lee2024. Herbal medicine, either as an alternative or add-on therapy, can also improve cough severity, quality of life, and reduce recurrence rates, though the certainty of evidence is moderate to low due to study bias Lee2023Lee2024. East Asian traditional medicine, which often combines herbal and acupuncture therapies, has shown positive outcomes in most studies, but higher-quality research is needed .
Conclusion
The treatment of cough begins with identifying and addressing underlying causes, which is effective in most cases. For chronic or refractory cough, neuromodulators like gabapentin, low-dose morphine, and emerging therapies such as P2X3 receptor antagonists offer new hope. Non-pharmacological approaches, including speech pathology and acupuncture-related therapies, can further improve outcomes and quality of life. Herbal medicine and East Asian traditional medicine may also be beneficial, especially as adjuncts to conventional care, but more rigorous studies are needed to confirm their efficacy.
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