Dicpinigaitis P V, Morice A H, Birring S S, McGarvey L, Smith J A, Canning B J, Page C P
King's College London, Franklin Wilkins Building, 100 Stamford St., London, SE1 9NH, UK.
Pharmacol Rev. 2014 Mar 26;66(2):468-512. doi: 10.1124/pr.111.005116. Print 2014.
Cough remains a serious unmet clinical problem, both as a symptom of a range of other conditions such as asthma, chronic obstructive pulmonary disease, gastroesophageal reflux, and as a problem in its own right in patients with chronic cough of unknown origin. This article reviews our current understanding of the pathogenesis of cough and the hypertussive state characterizing a number of diseases as well as reviewing the evidence for the different classes of antitussive drug currently in clinical use. For completeness, the review also discusses a number of major drug classes often clinically used to treat cough but that are not generally classified as antitussive drugs. We also reviewed a number of drug classes in various stages of development as antitussive drugs. Perhaps surprising for drugs used to treat such a common symptom, there is a paucity of well-controlled clinical studies documenting evidence for the use of many of the drug classes in use today, particularly those available over the counter. Nonetheless, there has been a considerable increase in our understanding of the cough reflex over the last decade that has led to a number of promising new targets for antitussive drugs being identified and thus giving some hope of new drugs being available in the not too distant future for the treatment of this often debilitating symptom.
咳嗽仍然是一个严重的未得到解决的临床问题,它既是一系列其他病症(如哮喘、慢性阻塞性肺疾病、胃食管反流)的症状,也是不明原因慢性咳嗽患者本身存在的问题。本文回顾了我们目前对咳嗽发病机制以及多种疾病所具有的高咳状态的理解,同时也回顾了目前临床使用的不同类别镇咳药物的证据。为求全面,本综述还讨论了一些临床上常用于治疗咳嗽但通常不归类为镇咳药物的主要药物类别。我们还回顾了处于不同研发阶段的多种作为镇咳药物的药物类别。对于用于治疗如此常见症状的药物而言,或许令人惊讶的是,缺乏充分对照的临床研究来证明当今许多药物类别的使用依据,尤其是那些非处方药物。尽管如此,在过去十年里,我们对咳嗽反射的理解有了相当大的进展,这使得一些有前景的镇咳新药靶点得以确定,从而让人们有希望在不久的将来获得新药来治疗这种常常使人衰弱的症状。