1. The patient had frequent and severe cough, less or no sputum volume, no itchy throat, nasal congestion, runny nose, belching, acid reflux and other symptoms.
For this type of patients, it is recommended to use only single-ingredient antitussives. Antitussives can be divided into peripheral antitussives and central antitussives. Commonly used in clinical are dextromethorphan, pentoxyverine and phenproperine.
- Dextromethorphan is a commonly used antitussive drug in clinical practice. Its effects are similar to codeine, but without the hypnotic and analgesic effects. Therapeutic doses generally have no inhibitory effect on the respiratory center and are not addictive. Adults are orally administered three times a day, 15 to 30 mg each time.
- Pentoxyverine also has antispasmodic and anticonvulsant properties. It should be used with caution in patients with cardiac insufficiency and glaucoma. Adults are orally administered three times a day, 25 mg each time.
- Phenproperine is a non-narcotic antitussive that inhibits peripheral afferent nerves. It also has some central cough-relieving effects. Adults are orally administered three times a day, 20 to 40 mg each time.
Phenproperine is the first choice for patients with severe cough, followed by dextromethorphan. Phenproperine or pentoxyverine is recommended for patients with an irritating dry cough. Phenproperine is indicated for patients with a cough that occurs mainly during the day. Dextromethorphan is used for patients who cough mainly at night. Studies have pointed out that the same dose of codeine and dextromethorphan have similar effects in reducing the frequency of chronic cough, but the antitussive effect of codeine is not as strong as dextromethorphan. In addition, dextromethorphan had no significant effect on treating nocturnal cough in children.
2. Patients with cough and phlegm or phlegm that is difficult to cough up.
The use of antitussives alone is not suitable for this type of patients, especially strong antitussives such as codeine. They reduce the secretion of the bronchial glands. It makes mucus thick and difficult to cough up. Not only can it worsen the infection, it can even increase the risk of choking. Therefore, mucolytics or expectorants (eg, acetylcysteine, ambroxol, ammonium chloride, bromhexine) should be the mainstay of treatment for this type of patient. Expectorant therapy enhances the clearing effect of cough on airway secretions. They increase phlegm discharge and enhance the antitussive effect.
Ambroxol and bromhexine are mucolytics. Bromhexine is metabolized into ambroxol in the human body. It reduces the viscosity of secretions and promotes ciliary movement in the airways. In addition, it can increase the concentration of antibacterial drugs in the respiratory tract.
- Ambroxol: Adults take 30-60 mg orally three times a day.
- Bromhexine: Adults take 8-16 mg orally three times a day.
Acetylcysteine can reduce the viscosity of the patient's sputum. Adults take 600 mg orally once or twice a day, or 200 mg (granules) three times a day.
3. Patients with dry cough or low sputum production and nasal symptoms such as runny nose and/or nasal congestion and sneezing.
This cough is usually caused by a cold or rhinitis. Antihistamines or decongestants can significantly relieve cough symptoms in these patients. However, caution should be exercised when prescribing these medications for children. Central or peripheral antitussives can be used in patients with severe cough. First-generation antihistamines (chlorpheniramine), decongestants (ephedrine, pseudoephedrine), and antitussives (codeine, dextromethorphan, pholcodine) are used to treat the common cold with cough. Medications containing codeine are contraindicated for children under 18 years of age. Drugs containing ephedrine and pseudoephedrine should be used with caution in patients with hypertension and heart disease.
4. Patients cough with shortness of breath or wheezing but no nasal symptoms.
It is recommended to treat this type of patient with drugs that suppress bronchospasm and relieve cough during asthma attacks, such as aminophylline and methoxyphenamine. When patients use aminophylline, lincosamides (clindamycin, lincomycin), macrolides (clarithromycin, erythromycin, roxithromycin), quinolones (ciprofloxacin, norfloxacin, ofloxacin), tetracyclines (doxycycline, minocycline). They inhibit the excretion of aminophylline and cause aminophylline poisoning. Azithromycin and moxifloxacin can be used in combination with aminophylline because they have no obvious interaction.
5. Patients with cough accompanied by one or more symptoms of typical acid reflux, such as acid reflux, belching, burning sensation behind the breastbone, and epigastric fullness.
This cough is due to gastroesophageal reflux. Patients are generally treated for the cause and do not require antitussive therapy.
6. Cough caused by cough variant asthma, eosinophilic bronchitis, allergic cough, pharyngitis, drug-induced cough, and psychogenic cough.
Antitussive therapy is generally not required for these patients. Treatment should be directed at the cause of the patient's cough.
