The difficult-to-treat, therapy-resistant cough: why are current cough treatments not working and what can we do?

Pulm Pharmacol Ther. 2013 Oct;26(5):528-31. doi: 10.1016/j.pupt.2013.05.001. Epub 2013 May 15.


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.

Keywords: Cough; Idiopathic; Treatment.

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Antitussive Agents / therapeutic use*
  • Chronic Disease
  • Cough / therapy*
  • Drug Resistance
  • Guideline Adherence
  • Humans
  • Patient Compliance
  • Practice Guidelines as Topic*
  • Randomized Controlled Trials as Topic
  • Speech Therapy / methods


  • Analgesics, Opioid
  • Anti-Bacterial Agents
  • Antidepressive Agents
  • Antitussive Agents