Pharmacology of cough in palliative care.

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.