1. Dr. Kashif Hussain

2. COUGH
Protective mechanism
Forceful expiration to remove foreign body,mucus or
secretions

3. Cough Reflex
1) cough receptors
airways,pleura, upper
GIT,pericardium,ears and diaphragm
2) afferent nerve
3) cough center
4) efferent nerves
5) effectors

4. Types of Cough
Dry Cough
Productive cough
 Acute cough
< 3 wks ( acute RTI)

5. Subacute cough
3-8 wks( BHR )
Chronic cough
> 8 wks (asthma,GERD,PND)

6. Goals of Therapy
1.Treat underlying cause of cough
2.productive cough( Mucolytics & Expectorants)
3.suppress dry cough (Anti-tussives)
4.Bronchodilators
5.ICS

7. Antitussives
Central acting
Decrease sensitivity of cough center to
peripheral stimuli and decrease mucosal
secretion

8. 1. OPIATES
Codeine ( GOLD STANDARD )
Pholcodine
Morphine and methadone for intractable
cough due to lung cancer

9. Antitussive effect occur at doses lower than
those required for analgesia therefore S/E are
less common but still occur and include:
1. Constipation
2. dysphoria
3. fatigue
4. addictive potential

10. 2.Opioid derivatives
Dextromethorphan
Noscapine
Levopropoxyphene

11. Dextromethorphan
• Synthetic derivative of morphine
• Central acting
• No analgesic effect in antitussive doses
• Low addictive profile

12. • Less constipation than codeine
• Significantly better S/E profile than codeine
• Equally effective as codeine for cough
suppression

13. 2.PERIPHERAL ACTING
 Benzonatate
local anesthetic effect in respiratory tract
and pleura
Thalidomide
Cough due to IPF(idiopathic pulmonary
fibrosis).Serious S/E is teratogenicity

14. OTHERS
Diphenhydramine (Antihistamine)

15. EXPECTORANTS
increase bronchial secretions and help in
expulsion of sputum

16. CLASSIFICATION
1.Drugs that reflexly irritate bronchial mucosa
 Guaifenesin (Only expectorant approved by
FDA )
 Ammonium chloride
 Ammonium bicarbonate

17. 2. Drugs that directly irritate bronchial
mucosa
Sodium Iodide
Potassium Iodide

18. MUCOLYTICS
 decrease sputum viscosity
They cause depolymerization of
mucopolysaccharide protein fibers
They are useful in COPD

19.  N-Acetylcysteine
 Erdosteine
 Bromhexine
 Carbocysteine in COPD
 Methylcysteine
 DNAase 1 ( dornase alfa ) in Cystic fibrosis