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      State of the Art for Refractory Cough: Multidisciplinary Approach

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          Abstract

          Chronic cough is a common problem that can be refractory to medical treatment. Nonpharmaceutical management of chronic cough has an important role in well selected patients. This review article outlines the history of chronic cough management, current approaches to speech pathology management of the condition and new modalities of nonpharmaceutical treatment. There is a need for further research into nonpharmaceutical options with well described randomised control trials.

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          The global epidemiology of chronic cough in adults: a systematic review and meta-analysis.

          Woo-Jung Song, Yoon-Seok Chang, Shoaib Faruqi … (2015)
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            Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial.

            Nicole Ryan, Surinder Birring, Peter G Gibson (2012)
            Refractory chronic cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory chronic cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory chronic cough. We established the efficacy of gabapentin in patients with refractory chronic cough. This randomised, double-blind, placebo-controlled trial was undertaken at an outpatient clinic in Australia. Adults with refractory chronic cough (>8 weeks' duration) without active respiratory disease or infection were randomly assigned to receive gabapentin (maximum tolerable daily dose of 1800 mg) or matching placebo for 10 weeks. Block randomisation was done with randomisation generator software, stratified by sex. Patients and investigators were masked to assigned treatment. The primary endpoint was change in cough-specific quality of life (Leicester cough questionnaire [LCQ] score) from baseline to 8 weeks of treatment, analysed by intention to treat. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12608000248369. 62 patients were randomly assigned to gabepentin (n=32) or placebo (n=30) and ten patients withdrew before the study end. Gabapentin significantly improved cough-specific quality of life compared with placebo (between-group difference in LCQ score during treatment period 1·80, 95% CI 0·56-3·04; p=0·004; number needed to treat of 3·58). Side-effects occurred in ten patients (31%) given gabapentin (the most common being nausea and fatigue) and three (10%) given placebo. The treatment of refractory chronic cough with gabapentin is both effective and well tolerated. These positive effects suggest that central reflex sensitisation is a relevant mechanism in refractory chronic cough. National Health and Medical Research Council of Australia and Hunter Medical Research Institute, Newcastle, Australia. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy.

              R. John Irwin, Gerard Curley, Christopher C. French (1990)
              A successful, systematic, anatomic, diagnostic protocol for evaluating patients with chronic cough was presented in 1981. To determine whether it was still valid, we prospectively evaluated, over a 22-month interval, 102 consecutive and unselected immunocompetent patients complaining of cough an average of 53 +/- 97 months (range, 3 wk to 50 yr). Utilizing the anatomic, diagnostic protocol modified to include prolonged esophageal pH monitoring (EPM), the causes of cough were determined in 101 of 102 (99%) patients, leading to specific therapy that was successful in 98%. Cough was due to one condition in 73%, two in 23%, and three in 3%. Postnasal drip syndrome was a cause 41% of the time, asthma 24%, gastroesophageal reflux (GER) 21%, chronic bronchitis 5%, bronchiectasis 4%, and miscellaneous conditions 5%. Cough was the sole presenting manifestation of asthma and GER 28 and 43% of the time, respectively. While history, physical examination, methacholine inhalational challenge (MIC), and EPM yielded the most frequent true positive results, MIC was falsely positive 22% of the time in predicting that asthma was the cause of cough. Laboratory testing was particularly useful in ruling out suspected possibilities. We conclude that the anatomic diagnostic protocol is still valid and that it has well-defined strengths and limitations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Tuberc Respir Dis (Seoul)
                Journal ID (iso-abbrev): Tuberc Respir Dis (Seoul)
                Journal ID (publisher-id): TRD
                Title: Tuberculosis and Respiratory Diseases
                Publisher: The Korean Academy of Tuberculosis and Respiratory Diseases
                ISSN (Print): 1738-3536
                ISSN (Electronic): 2005-6184
                Publication date (Print): October 2023
                Publication date (Electronic): 11 August 2023
                Volume: 86
                Issue: 4
                Pages: 264-271
                Affiliations
                [1 ]Department of Speech Pathology, John Hunter Hospital, Newcastle, Australia
                [2 ]School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
                [3 ]Department of Asthma and Breathing, Hunter Medical Research Institute, Newcastle, Australia
                Author notes
                Address for correspondence Anne E. Vertigan, Ph.D. Department of Asthma and Breathing, Hunter Medical Research Institute, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW 2310, Australia Phone 61-249213726 E-mail anne.vertigan@ 123456health.nsw.gov.au
                Author information
                http://orcid.org/0000-0002-4712-8576
                Article
                Publisher ID: trd-2023-0036
                DOI: 10.4046/trd.2023.0036
                PMC ID: 10555522
                PubMed ID: 37582675
                SO-VID: 44b7630a-3fe6-4d55-b1b6-5493b72ae2e3
                Copyright © Copyright © 2023 The Korean Academy of Tuberculosis and Respiratory Diseases
                License:

                It is identical to the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/).

                History
                Date received : 17 March 2023
                Date revision received : 8 June 2023
                Date accepted : 31 July 2023
                Categories
                Subject: Review
                Subject: Miscellaneous

                ScienceOpen disciplines: Respiratory medicine
                Keywords: speech pathology,nonpharmaceutical,chronic cough,inducible laryngeal obstruction,vocal cord dysfunction
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: speech pathology, nonpharmaceutical, chronic cough, inducible laryngeal obstruction, vocal cord dysfunction

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