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Related Experiment Videos

Codeine and cough: an ineffective gold standard.

Donald C Bolser1, Paul W Davenport

  • 1Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida 32610, USA. bolserd@mail.vetmed.ufl.edu

Current Opinion in Allergy and Clinical Immunology
|January 16, 2007
PubMed
Summary
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Codeine, a long-standing cough suppressant, may not be more effective than placebo for certain coughs. New research suggests a complex cough control system may explain these findings and guide future research.

Area of Science:

  • Pharmacology
  • Respiratory Medicine
  • Neuroscience

Background:

  • Cough is a prevalent symptom leading to physician visits.
  • Codeine has historically been considered the gold standard for cough suppression.
  • Recent studies challenge codeine's efficacy, contrasting with older findings.

Purpose of the Study:

  • To investigate the efficacy of codeine as a cough suppressant.
  • To understand the discrepancies in recent and older studies on codeine's effectiveness.
  • To propose a novel framework for understanding cough regulation.

Main Methods:

  • Review of recent placebo-controlled studies on codeine efficacy.
  • Analysis of older placebo-controlled studies.
  • Synthesis of findings with animal model data.

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Main Results:

  • Recent studies indicate codeine is not superior to placebo for coughs from upper respiratory disorders or COPD.
  • This contradicts some older studies that showed codeine's effectiveness.
  • The reasons for these conflicting results remain unclear.

Conclusions:

  • A complex hierarchical control system (holarchy) regulating cough expression is proposed.
  • This system involves interacting regulatory elements called holons.
  • Codeine may act on an intermediate-order holon, whose role in human cough is context-dependent, explaining variable efficacy.