Chest
Original Research: Signs and Symptoms of Chest DiseasesPregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial
Section snippets
Methods
This study was a randomized, double-blind, placebo (PLAC)-controlled trial that was approved by the Hunter New England Research Ethics Committee (approval number 11/11/16/3.04) and registered with the Australian and New Zealand clinical trials register (12611001186943). All participants gave written informed consent.
Results
We screened 114 people with chronic cough between March 2012 and June 2014 and randomized 40 who met the study inclusion criteria of CRC of more than 8 weeks’ duration (Table 2). Twenty participants were randomized to each group, with 17 completing treatment in the SP + PREG group and 18 in the SP + PLAC group (Fig 2). Reasons for noncompletion are reported in Figure 2. The mean duration of cough was 123 months (SD, 119; range, 3-480). Pretreatment values were similar between groups for the
Discussion
This randomized, controlled trial demonstrated that when SPT is combined with the neuromodulator PREG, there is a significantly greater improvement in perceived cough severity and cough QOL than with SPT alone. Cough reflex sensitivity was improved by the addition of SP to PREG, which is significant because gabapentin, a similar agent to PREG, did not improve cough reflex sensitivity.7 The magnitude of the urge to cough at the end of capsaicin cough sensitivity testing was also reduced in both
Conclusion
Combined SPT and PREG is beneficial in reducing symptoms in CRC. Although it causes some adverse effects, these resolve upon drug cessation. When PREG is used in combination with SPT, the beneficial effects continue for at least 4 weeks after cessation of PREG. These results are consistent with the emerging concepts of sensory hyperresponsiveness as a mechanism of CRC.
Acknowledgments
Author contributions: A. E. V. takes responsibility for the content of the manuscript, including the data and analysis;was the study coordinator, designed, supervised, and provided the speech pathology treatment; conducted data analysis; and drafted the paper. S. L. K. provided the speech pathology treatment, conducted the capsaicin cough testing, and analyzed cough monitor data. N. M. R. conducted capsaicin cough testing and analyzed cough monitor data. S. S. B. consulted on the cough monitor
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FUNDING/SUPPORT: This project was supported by the Division of Medicine, John Hunter Hospital, and National Health and Medical Research Council project grant. Prof Gibson is supported by a National Health and Medical Research Council Practitioner Research Fellowship. Dr Ryan was supported by a John Hunter Hospital Charitable Trust Award [G1300784].