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Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study
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 rea...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10126594/ https://www.ncbi.nlm.nih.gov/pubmed/37078383 http://dx.doi.org/10.1177/17534666231167716 |
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author | Zhang, Mengru Morice, Alyn H. Si, Fengli Zhang, Li Chen, Qiang Wang, Shengyuan Zhu, Yiqing Xu, Xianghuai Yu, Li Qiu, Zhongmin |
author_facet | Zhang, Mengru Morice, Alyn H. Si, Fengli Zhang, Li Chen, Qiang Wang, Shengyuan Zhu, Yiqing Xu, Xianghuai Yu, Li Qiu, Zhongmin |
author_sort | Zhang, Mengru |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10126594 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-101265942023-04-26 Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study Zhang, Mengru Morice, Alyn H. Si, Fengli Zhang, Li Chen, Qiang Wang, Shengyuan Zhu, Yiqing Xu, Xianghuai Yu, Li Qiu, Zhongmin Ther Adv Respir Dis Original Research 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. SAGE Publications 2023-04-20 /pmc/articles/PMC10126594/ /pubmed/37078383 http://dx.doi.org/10.1177/17534666231167716 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Zhang, Mengru Morice, Alyn H. Si, Fengli Zhang, Li Chen, Qiang Wang, Shengyuan Zhu, Yiqing Xu, Xianghuai Yu, Li Qiu, Zhongmin Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title | Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title_full | Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title_fullStr | Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title_full_unstemmed | Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title_short | Antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
title_sort | antitussive efficacy of the current treatment protocol for refractory chronic cough: our real-world experience in a retrospective cohort study |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10126594/ https://www.ncbi.nlm.nih.gov/pubmed/37078383 http://dx.doi.org/10.1177/17534666231167716 |
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