title: Effect of codeine on objective measurement of cough in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Codeine is the standard antitussive treatment to which novel agents are compared. Little is known about the objective effect of any treatments on cough in chronic obstructive pulmonary disease (COPD).
  
  
  OBJECTIVE
  To quantify the effect of codeine on objective cough frequency (quantified as time spent coughing: cough seconds, cs/h), citric acid cough threshold, and subjective measures in a double-blind, placebo-controlled crossover study in COPD.
  
  
  METHODS
  We studied 21 patients with physician-diagnosed, stable disease who complained of cough (76.9% male; mean age, 67.7 years; mean predicted FEV(1), 53.4%; median smoking history, 43.5 pack-years). Each subject performed a cough challenge (single breath, citric acid), 10-hour daytime ambulatory and overnight cough recordings, subjective cough scores, and visual analog scales at baseline and on 2 study days, 1 week apart. Codeine phosphate 60 mg or matched placebo were given, in random order, at the start of each cough recording (0 and 12 hours).
  
  
  RESULTS
  Median time spent coughing at baseline was 8.27 cs/h (interquartile range [IQR], 5.94-11.67); after placebo treatment, 7.22 cs/h (IQR 4.42-10.40); and after codeine treatment, 6.41 cs/h (IQR 3.86-9.10). Codeine treatment had a significant effect on time spent coughing compared with baseline (P = .02) but not compared with placebo (P = .52). There were no significant differences in cough challenge thresholds (log concentration of tussive agent causing 2 coughs or log concentration of tussive agent causing 5 coughs) or subjective cough measures for codeine compared with placebo.
  
  
  CONCLUSIONS
  In this study, codeine was no more effective than placebo in patients with COPD complaining of cough.
  
  
  CONCLUSIONS
  Codeine is the antitussive agent to which we compare new treatments; however, in a group of stable patients with COPD, it had no effect on cough frequency over placebo.
authors.affiliation: North West Lung Centre, South Manchester University Hospitals Trust, Manchester, United Kingdom. jackyannsmith@hotmail.com
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Smith
authors.forename: Emily
authors.initials: E
authors.lastname: Owen
authors.forename: John
authors.initials: J
authors.lastname: Earis
authors.forename: Ashley
authors.initials: A
authors.lastname: Woodcock
mesh_terms: D000368:Aged; D000996:Antitussive Agents / Q000627:therapeutic use*; D019343:Citric Acid / Q000008:administration & dosage; D003061:Codeine / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology*; D012018:Reflex / Q000187:drug effects
chemical_list: D000996:Antitussive Agents; D019343:Citric Acid; D003061:Codeine