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Pharmacological Strategies in Cough Management: Rational Use of Fixed-Dose Combinations

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Cough is a physiological response to mechanical and chemical stimuli caused by irritation of cough receptors located primarily in the epithelium of the upper and lower respiratory tracts, as well as the pericardium, esophagus, diaphragm, and stomach.1 It is a vital defensive reflex that facilitates clearance of airway secretions, inhaled particulates, and pathogens, thereby protecting against aspiration. Clinically, cough is a common symptom associated with a wide spectrum of respiratory and nonrespiratory conditions, including infections, asthma, chronic bronchitis, chronic obstructive pulmonary disease, and pollution related airway disease. Based on duration, cough may be acute, subacute, or chronic, and based on presentation it may be dry or productive. Productive cough is characterized by sputum expectoration and often accompanies infectious etiologies. Pharmacological management focuses on rational use of fixed dose combinations, where expectorants reduce sputum viscosity and bronchodilators relieve airway obstruction. Combinations such as Bromhexine or Ambroxol with Guaifenesin, Menthol, and Terbutaline are commonly used to enhance mucociliary clearance and improve symptom control.2