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Pharmacology of cough in palliative care

Morice, Alyn H.a; Shanks, Gabriellab

Current Opinion in Supportive and Palliative Care: September 2017 - Volume 11 - Issue 3 - p 147–151
doi: 10.1097/SPC.0000000000000279
RESPIRATORY PROBLEMS: Edited by David C. Currow and Miriam J. Johnson

Purpose of review Cough is a common and distressing symptom. It has a marked decrement on quality-of-life particularly in the arena of palliative care where coexisting symptoms such as pain may be exacerbated. Whilst local definitive treatment may alleviate coughing it usually requires general measures. The purpose of the review is to assess the current evidence relating to the pharmacological management of cough.

Recent findings Key to understanding cough is the realization that most cough is because of a hypersensitivity of the afferent vagus nerve. Cough suppression with opioids and first-generation antihistamines may produce relief. However, much cough in palliative medicine is caused by unrecognized nonacid reflux and aspiration. Promotility agents may be dramatically effective at both preventing cough and recurrent aspiration.

Summary The implications of this review will aid practitioners understanding of cough in a variety of settings, including palliative care.

aHull York Medical School, Castle Hill Hospital

bDepartment of Medicine, Hull Royal Infirmary, Hull, UK

Correspondence to Alyn H. Morice, MD, FRCP, FBPhS, Hull York Medical School, Castle Hill Hospital, Hull HU16 5JQ, UK. Tel: +44 (0) 1482 624067; e-mail:

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