Curbing the Cough: Multimodal Treatments for Neurogenic Cough: A Systematic Review and Meta‐Analysis

Abstract

Objectives/Hypothesis Neurogenic cough affects 11% of Americans and causes significant detriment to quality of life. With the advent of novel therapies, the objective of this review is to determine how procedural therapies (e.g., superior laryngeal nerve block) compare to other established pharmacologic and non‐pharmacologic treatments for neurogenic cough. Methods With the assistance of a medical librarian, a systematic review was performed using PICOS (patients, interventions, comparator, outcome, study design) format: adults with neurogenic cough receiving any pharmacologic or non‐pharmacologic treatment for neurogenic cough compared to adults with neurogenic cough receiving any other relevant interventions, or treated as single cohorts, assessed with cough‐specific quality of life outcomes, in all study designs and case series with ≥ 10 cases. Case reports, review articles, non‐human studies, non‐English language articles, and unavailable full‐text articles were excluded. Results There were 2408 patients with neurogenic cough in this review, treated with medical therapy (77%), speech therapy (19%), both medical and speech therapy (1%), and procedural therapy (3%). The included studies ranged from low to intermediate quality. Overall, most interventions demonstrated successful improvement in cough. However, the heterogeneity of included study designs precluded direct comparisons between intervention types. Conclusion This meta‐analysis compared various treatments for neurogenic cough. Procedural therapy should be considered in the armamentarium of neurogenic cough treatments, particularly in patients refractory to, or intolerant of, the side effects of medical therapy. Lastly, this review illuminates key areas for improving neurogenic cough diagnosis, such as strict adherence to diagnostic and treatment guidelines, sophisticated reflux testing, and standardized, consistent outcome reporting. Laryngoscope, 132:107–123, 2022

Superior Laryngeal Nerve Block Response Rates in 54 Neurogenic Cough Patients

“…6,13 The most well-established non-pharmacologic treatment for neurogenic cough includes cough suppressive therapy with a speech and language pathologist. This therapy has been shown to improve patient cough-related quality of life, 15,16 but these interventions are often limited by cost, patient access to a therapist, and necessity of regular visits. 6,7 A recently emerging therapy that may be a more convenient option for patients is SLN block with local anesthetic and long-acting corticosteroid.…”

Non-pharmacological Management of Non-productive Chronic Cough in Adults: A Systematic Review

“…CPAP did improve cough in those with OSA, possibly by its impact on lung inflation or on gastro-esophageal reflux ( 23 , 26 , 27 ), however, its use in other chronic respiratory diseases is unexplored. A recent systematic review explored multimodal treatments for refractory chronic cough and concluded that medical therapy, SLP, and procedural therapy all improve outcomes of chronic cough ( 9 ). In this review, all study designs were included and SLP was described as including a large number of interventions, such as physiotherapy and behavioral therapy and no distinction between them was performed, which could have influenced the conclusions presented ( 9 ).…”

“…A recent systematic review explored multimodal treatments for refractory chronic cough and concluded that medical therapy, SLP, and procedural therapy all improve outcomes of chronic cough ( 9 ). In this review, all study designs were included and SLP was described as including a large number of interventions, such as physiotherapy and behavioral therapy and no distinction between them was performed, which could have influenced the conclusions presented ( 9 ). Our review compliments these results, by presenting the data from people with chronic respiratory diseases, including only the highest evidence available (RCTs) and differentiating between different disciplines and techniques performed for people with refractory chronic cough.…”

“…The two main forms of chronic cough management are pharmacological and non-pharmacological therapy (9)(10)(11). Currently there is only one pharmaceutical therapy under review for the treatment of refractory chronic cough (12), but approval is pending.…”

“…They have been reported to be equally effective, with fewer side effects, compared to pharmacological therapies (6,13), however, there is a paucity of information regarding which nonpharmacological therapies are most effective. Four systematic reviews of non-pharmacological management of chronic cough have been published in the past decade (9,(14)(15)(16), however they focused mainly on speech language pathology, neglecting other therapies such as behavioral therapies or relaxation (14,16), or focused on people with only refractory chronic cough, excluding those with chronic cough due to chronic respiratory diseases (9,15). Our systematic review adds to this field of research by including, both, people with refractory chronic cough or chronic respiratory diseases, and seeking to identify all non-pharmacological therapies.…”