The dearth of antitussives in development reflects the broad availability of over-the-counter antitussives. However, a key finding using newly developed cough monitoring systems is a lack of efficacy versus placebo of currently available antitussives. Coupled with advances in understanding the biology of cough, this has created an opportunity for the development of novel, improved antitussives. Several pharmaceutical companies are recognizing this strategic opening and as a consequence are making an effort to develop heretofore seldom heard of “antitussive pipelines”. Potential next generation antitussives may act on the nervous system to control an inappropriate (pathological) urge-to-cough or, in the case of productive cough, facilitate expectoration, thus reducing the need to cough.