title: The difficult-to-treat, therapy-resistant cough: why are current cough treatments not working and what can we do?
abstract: Cough can persist despite exhaustive diagnostic and therapeutic effort and has been termed 'idiopathic' or 'unexplained' but perhaps 'difficult to treat' cough is a more appropriate description. In this article the reasons for poor treatment response are discussed. These include a lack of physician fidelity to management guidelines, patient non-adherence and the lack of effective medicines. A number of randomized controlled trials have been undertaken including low dose opiate therapy, the use of a speech pathology intervention, oral antibiotics and antidepressants. The success or otherwise of such interventions will be discussed. A number of approaches to deal with the problem of 'difficult to treat cough' will be considered.
authors.affiliation: Centre for Infection and Immunity, Health Sciences Building, Queens University Belfast, Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK. l.mcgarvey@qub.ac.uk
authors.forename: Lorcan
authors.initials: L
authors.lastname: McGarvey
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000996:Antitussive Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003371:Cough / Q000628:therapy*; D004351:Drug Resistance; D019983:Guideline Adherence; D006801:Humans; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D013070:Speech Therapy / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D000900:Anti-Bacterial Agents; D000928:Antidepressive Agents; D000996:Antitussive Agents
keywords: Cough; Idiopathic; Treatment