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Review ArticleReview Article

Antitussive Drugs—Past, Present, and Future

P.V. Dicpinigaitis, A.H. Morice, S.S. Birring, L. McGarvey, J.A. Smith, B.J. Canning and C.P. Page
David R. Sibley, ASSOCIATE EDITOR
Pharmacological Reviews April 2014, 66 (2) 468-512; DOI: https://doi.org/10.1124/pr.111.005116
P.V. Dicpinigaitis
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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A.H. Morice
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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S.S. Birring
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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L. McGarvey
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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J.A. Smith
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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B.J. Canning
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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C.P. Page
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
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David R. Sibley
Albert Einstein College of Medicine and Montefiore Medical Centre, Department of Medicine, Bronx, New York (P.V.D);Centre for Cardiovascular and Metabolic Medicine, Castle Hill Hospital, Hull York Medical School, University of Hull, Hull, United Kingdom (A.H.M.); Division of Asthma, Allergy & Lung Biology, King’s College London, Denmark Hill, London, United Kingdom (S.S.B.); Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom (L.M.); Respiratory Research Group, University of Manchester, University Hospital of South Manchester, Manchester, United Kingdom (J.A.S.); Johns Hopkins Asthma and Allergy Center, Baltimore, Maryland (B.J.C.); and Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King’s College London, Franklin-Wilkins Building, London, United Kingdom (C.P.P.)
Roles: ASSOCIATE EDITOR
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Abstract

Cough remains a serious unmet clinical problem, both as a symptom of a range of other conditions such as asthma, chronic obstructive pulmonary disease, gastroesophageal reflux, and as a problem in its own right in patients with chronic cough of unknown origin. This article reviews our current understanding of the pathogenesis of cough and the hypertussive state characterizing a number of diseases as well as reviewing the evidence for the different classes of antitussive drug currently in clinical use. For completeness, the review also discusses a number of major drug classes often clinically used to treat cough but that are not generally classified as antitussive drugs. We also reviewed a number of drug classes in various stages of development as antitussive drugs. Perhaps surprising for drugs used to treat such a common symptom, there is a paucity of well-controlled clinical studies documenting evidence for the use of many of the drug classes in use today, particularly those available over the counter. Nonetheless, there has been a considerable increase in our understanding of the cough reflex over the last decade that has led to a number of promising new targets for antitussive drugs being identified and thus giving some hope of new drugs being available in the not too distant future for the treatment of this often debilitating symptom.

Footnotes

  • P.V.D., A.H.M., S.S.B., L.M., J.A.S., B.C., and C.P.P. contributed equally to this work.

  • dx.doi.org/10.1124/pr.111.005116

  • Copyright © 2014 by The American Society for Pharmacology and Experimental Therapeutics
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Pharmacological Reviews: 66 (2)
Pharmacological Reviews
Vol. 66, Issue 2
1 Apr 2014
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Review ArticleReview Article

Antitussive Drugs

P.V. Dicpinigaitis, A.H. Morice, S.S. Birring, L. McGarvey, J.A. Smith, B.J. Canning and C.P. Page
Pharmacological Reviews April 1, 2014, 66 (2) 468-512; DOI: https://doi.org/10.1124/pr.111.005116

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Review ArticleReview Article

Antitussive Drugs

P.V. Dicpinigaitis, A.H. Morice, S.S. Birring, L. McGarvey, J.A. Smith, B.J. Canning and C.P. Page
Pharmacological Reviews April 1, 2014, 66 (2) 468-512; DOI: https://doi.org/10.1124/pr.111.005116
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  • Article
    • Abstract
    • I. Cough as an Unmet Clinical Problem
    • II. Basic Physiology of the Cough Reflex
    • III. Drugs in Current Use for the Treatment of Cough
    • IV. Other Drugs Having an Effect on Cough
    • V. New Approaches to Treating Cough
    • VI. Clinical Trial Design for Evaluation of Antitussive Drugs
    • VII. Conclusions—What’s Needed
    • Footnotes
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