Codeine, Cough and Upper Respiratory Infection

doi:10.1006/pulp.1996.0038

Pulmonary Pharmacology

Volume 9, Issues 5–6, October 1996, Pages 293-297

https://doi.org/10.1006/pulp.1996.0038 Get rights and content

Abstract

Codeine is generally accepted as a standard or reference antitussive against which new antitussive medications can be compared. However there are very few studies which have investigated the antitussive efficacy of codeine using cough associated with upper respiratory tract infection (URTI) and there is little if any evidence to support the antitussive efficacy of codeine in this model. This paper discusses the mechanism of cough in man and describes some clinical investigations on the effects of codeine on cough associated with URTI. The recent clinical investigations do not provide any evidence to support an antitussive action of codeine in the treatment of cough associated with URTI yet there is evidence in the literature which indicates that codeine inhibits fictive cough in animal models and also has antitussive activity against both induced and chronic cough models in man. In order to explain these different effects of codeine on the different models of cough, a hypothesis is put forward that there are two cough pathways in man. A voluntary pathway associated with cough related to URTI which is not affected by codeine, and a reflex pathway associated with induced and chronic cough which is inhibited by codeine

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This has been considered as the underlying mechanism of reduction of cough of tracheal origin by oral codeine (Adcock et al., 1988). Although the focus of the present study was not to study the influence of codeine on cough that is produced by stimulation of epithelial receptors by irritants in upper respiratory tract infections (Eccles, 1996) but on dyspnoea and dry (unproductive) cough that are characteristic clinical signs of left ventricular insufficiency (Braunwald, 1988) (when the J receptors would be stimulated by the accompanying pulmonary congestion) yet the mechanism of codeine's action could be similar. The possibility of a direct action of codeine on the medulla is as likely as its action on the peripheral components of the reflex.
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Mean increase in minute ventilation at the end of 8 min of incremental treadmill walking after codeine was 21% less than after placebo (P < 0.05); 60% of the subjects continued to walk for an additional 4 min and the onset of respiratory discomfort was delayed by 1–5 min.
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Regular ArticleCodeine, Cough and Upper Respiratory Infection☆

Abstract

Regular Article
Codeine, Cough and Upper Respiratory Infection☆