Coughing is a vital defensive reflex that allows clearance of excessive airway secretions and prevents the entry of foreign bodies into the respiratory tract. 1 Cough is classified into three categories based on its duration: acute (<3 weeks), subacute (3-8 weeks), and chronic (>8 weeks in adults and >4 weeks in children). 234 Acute cough episodes are mainly related to upper respiratory tract infections (URTI). The other underlying causes of acute cough are pneumonia, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) exacerbation, aspiration, and pulmonary embolism. 5

The American College of Chest Physicians (ACCP) defines subacute cough as cough that resolves spontaneously on its own, with negative chest radiography ruling out pneumonia4 Chronic cough can be caused by many diseases including asthma, gastroesophageal reflux disease (GERD), chronic bronchitis, bronchiectasis, and postnasal drip.6 Cough can also be categorized based on the sputum volume as dry and wet cough. Wet cough is also known as productive cough and is defined as sputum volume >10 mL per day.4,7 A dry cough is also known as unproductive cough and is characterized by no mucus production. Chronic cough may indicate a more serious underlying medical condition such as asthma, postnasal drip, and gastric reflux disease.8 Patients with the acute and sub-acute cough usually self-medicate with over the counter (OTC) antitussive drugs, although a careful examination and patient history is required to identify the underlying causes. OTC drugs which include combinations of antihistamines, decongestants, cough suppressants and expectorants are most used preparations for self-medication.9 Current ACCP guidelines recommend nonpharmacologic and pharmacologic treatments based on patient comorbid disease status and underlying chronic cough causes. Pharmacologic treatment usually consists of a bronchodilator, corticosteroid, leukotriene receptor antagonists and inhaled anticholinergic etc. 10 Antitussive drugs are commonly used cough suppressants which include centrally acting (opioids and non-opioids) cough suppressants and peripheral antitussives. Codeine, dextromethorphan and cloperastine are among the most common central agents that act by inhibiting the cough center in the brain.11 Peripherally acting antitussives such as levodropropizine and moguisteine exhibit a very strong antitussive activity. Levodropropizine is an orally administered non-opioid anti-tussive agent whose peripheral antitussive action may result from its modulation of sensory neuropeptide levels within the respiratory tract.121314 In India, levodropropizine was approved by The Central Drugs Standard Control Organization in 2005 for the treatment of dry cough in adult patient. 15 The current ACCP and ERS guidelines also suggest using alternative antitussive strategy in subset of patients with cough resistant to other treatments.16

There is a need to find an effective antitussive medication with a high tolerability profile because the usage of the currently available centrally acting antitussive for the treatment of cough is severely restricted by the central depressive action and abusive side effects. 17 This review article aims to summarize the potential mechanism of action, comparative effectiveness, and safety profile of levodropropizine for symptomatic treatment of cough in paediatric and adult population. Its impact on patients’ health-related quality of life (HRQoL) and in managing COVID-19 associated cough have also been discussed.