(See Fig. 47-2)

• When possible, therapy of cough is that of underlying disease. Eliminate ACE inhibitors and cigarette smoking.
• If no cause can be found, a trial of an inhaled anticholinergic agent (e.g., ipratropium 2-4 puffs four times daily), an inhaled β agonist (e.g., albuterol) or an inhaled steroid (e.g., triamcinolone) can be attempted. Inhaled steroids may take 7-10 days to be effective when used for an irritative cough.
• Cough productive of significant volumes of sputum should generally not be suppressed. Sputum clearance can be facilitated with adequate hydration, expectorants, and mechanical devices. Iodinated glycerol (30 mg four times daily) may be useful in asthma or chronic bronchitis.
• When symptoms from an irritative cough are severe, the cough may be suppressed with a narcotic antitussive agent such as codeine, 15-30 mg up to four times a day, or a nonnarcotic such as dextromethorphan (15 mg four times a day).

Figure 47-2
Algorithm for management of cough lasting >3 weeks. Cough between 3 and 8 weeks is considered subacute; cough >8 weeks is considered chronic. Hx, history, PE, physical examination; ACEI, angiotensin-converting enzyme inhibitor; Rx, treat; CXR, chest x-ray. (From SE Weinberger, DA Lipson, in HPIM-17, p. 226.)

---

NEXT:
Hemoptysis

CHAPTER:
Cough and Hemoptysis