Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study

Abstract

Background: The management of refractory chronic cough (RCC) is a great challenge. Neuromodulators have long been used for RCC with imperfect efficacy. Objectives: We summarized the outcomes of the current treatments used at our specialist cough clinic, which provides a guideline-led service and real-world experience for the future management of RCC. Design: This is a single-centre retrospective observational cohort study. Methods: Consecutive RCC patients (the first clinic visit between January 2016 and May 2021) were included into this observational cohort study. Medical records in the Chronic Cough Clinical Research Database were fully reviewed using uniform criteria. The included subjects were followed-up for at least 6 months after the final clinic visit via instant messages with the link to self-scaled cough-associated questionnaires. Results: Overall, 369 RCC patients were analysed with a median age of 46.6 years and a cough duration of 24.0 months. A total of 10 different treatments were offered. However, 96.2% of patients had been prescribed at least one neuromodulator. One-third of patients had alternative treatments prescribed given the poor response to the initial therapy and 71.3% favourably responded to at least one of the treatments. Gabapentin, deanxit, and baclofen had comparable therapeutic efficacy (56.0%, 56.0%, and 62.5% respectively; p = 0.88) and overall incidences of adverse effects (28.3%, 22.0%, and 32.3% respectively; p = 0.76). However, 19.1 (7.7–41.8) months after the last clinic visit, 65.0% reported improvement (24.9%) or control of their cough (40.1%); 3.8% reported a spontaneous remission and 31.2% still had a severe cough. Both HARQ ( n = 97; p < 0.001) and LCQ ( n = 58; p < 0.001) demonstrated marked improvement. Conclusion: Trying different neuromodulators is a pragmatic strategy for RCC, which helped around two-thirds of patients. Relapse is common on withdrawal or reduction of dosage. Novel medication for RCC is an urgent clinical need. Plain language summary This is the first report that fully represented a guideline-led treatment protocol for refractory chronic cough (RCC) based on a large series of patients, which evaluated the short- and long-term effects of the currently available treatments for RCC. We found that the therapeutic trial of different neuromodulators is a pragmatic strategy, which helped around two-thirds of patients. Gabapentin, deanxit (flupentixol/melitracen), and baclofen had similar therapeutic outcomes. This study may offer real-world experience for the future management of RCC.

Role of alveolar nitric oxide in gastroesophageal reflux-associated cough: prospective observational study

“…The decreased CaNO combined with cough relief also suggests the potential for CaNO to be used in predicting the response to anti-reflux treatment and being used as a treatment outcome indicator in real-world practice. Since relapse may occur upon withdrawal of treatment or reduction of dosage, 16 regular CaNO follow-ups may better guide the course of therapy. Currently, several MII-pH parameters such as SAP, AET, and mean nocturnal baseline impedance are used to predict GERC.…”

“…Consecutive patients with GERC and non-GERC who visited our cough clinic between March 2021 and October 2022 were recruited into the study. A GERC diagnosis was considered when the following criteria were met: (I) the patient presented with a cough which had lasted for at least 2 months; (II) multichannel intraluminal impedance and pH monitoring (MII-pH) revealed abnormal gastroesophageal reflux: acid exposure time (AET) >6%, symptom association probability (SAP) ⩾ 95%, and reflux episodes >80 times in 24 h 13 ; and (III) cough responded to a stepwise anti-reflux treatment protocol, 14 – 16 available in Supplemental Table 1 . Patients with predominant abnormal acidic and non-acidic reflux were diagnosed with acid GERC and non-acid GERC, respectively.…”

Search for the Natural Remedies for the Treatment of Dry Cough

“…These drugs may potentially induce hepatic and renal injuries (Kayode, Kayode, and Oridota 2021) About the use of neuromodulators, like gabapentin, for refractory chronic cough (RCC) management a study found that despite the efficacy of these agents, relapse was more common upon withdrawal or reduction of dosage. The study emphasized the dire need for developing novel medication for RCC management (Zhang et al 2023).…”