Efficacy of sequential three-step empirical therapy for chronic cough

Abstract

Background:Empirical three-step therapy has been proved in just one hospital. This study aimed to demonstrate applicability of the sequential empirical three-step therapy for chronic cough in different clinical settings.Methods:Sequential empirical three-step therapy was given to patients with chronic cough in one tertiary and three secondary care respiratory clinics. Recruiters were initially treated with methoxyphenamine compound as the first-step therapy, followed by corticosteroids as the second-step therapy and the combination of a proton-pump inhibitor and a prokinetic agent as the third-step therapy. The efficacy of the therapy was verified according to the changes in cough symptom score between pre- and post-treatment, and compared among the different clinics.Results:In total 155 patients in one tertiary clinic and 193 patients in secondary care clinics were recruited. The total dropout ratio is significantly higher in the secondary care clinics than that in the tertiary clinic (9.3% versus 3.2%, p = 0.023). The therapeutic success rate for cough was 38.7% at first-step therapy, 32.3% at second-step therapy and 20.0% at third-step therapy in the tertiary clinic, and comparable to corresponding 49.7%, 31.1% and 4.1% in secondary care clinics. Furthermore, the overall cough resolution rate was not significantly different (91.0% versus 85.0%, p = 0.091). However, the efficacy of the third-step therapy is much higher (20.0% versus 4.1%, p = 0.001) in the tertiary clinic than in the secondary care clinics.Conclusions:Sequential empirical three-step therapy is universally efficacious and useful for management of chronic cough in different clinical settings.

Prediction of Therapeutic Efficacy of Gabapentin by Hull Airway Reflux Questionnaire in Chronic Refractory Cough

“…Gastroesophageal re ux can be a determinant of CRC since about 36% of patients with cough due to re ux are resistant to anti-re ux medicinal treatment 15 and need the neuromodulators as add-on therapy 7,16,30 . The underlying mechanisms include incomplete acid suppression, non-acid re ux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity 30 , which are generally associated with peripheral sensitization of cough re ex.…”

“…Cough severity was evaluated by the validated Chinese version of cough symptom scores described by Hsu et al 14 , which rates daytime and nighttime cough on a six-point scale from 0 to 5 (0 indicates no cough; 5 indicates the most severe cough). The therapeutic success was de ned as cough control (cough disappeared) or improvement (cough symptom score decreased by ≥50%) after gabapentin treatment 8,[15][16][17] .…”

Prediction of therapeutic efficacy of gabapentin by Hull Airway Reflux Questionnaire in chronic refractory cough

“…Therapeutic success was defined as cough control (cough disappeared) or improvement (cough symptom score decreased by ⩾50%) after gabapentin treatment. 8 , 14 – 16 …”

“…Therapeutic success was defined as cough control (cough disappeared) or improvement (cough symptom score decreased by ⩾50%) after gabapentin treatment. 8,[14][15][16] Cough sensitivity was assessed by inhaled capsaicin challenge and the validated Chinese version of HARQ. 17 The former was performed according to the protocol described by Fujimura et al but adapted to the ERS guidelines, 18,19 and cough thresholds C2 and C5 were defined as the minimum concentration of capsaicin stimulating ⩾2 or ⩾5 coughs, respectively.…”

Gastroesophageal reflux disease and chronic cough: A possible mechanism elucidated by ambulatory pH‐impedance‐pressure monitoring

“…3 Acid reflux has been identified as one of the most important causes of chronic cough and some patients with CC benefit from anti-acid therapy. 4,5 However, many patients experience significant adverse effects of anti-acid therapy without benefit. Studies have also shown that weakly acidic reflux plays a role in reflux-induced cough.…”