Gabapentin worked for chronic cough - thank goodness, something did (RCT) - PulmCCM
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Sep 202012
 
randomized controlled trials outpatient pulmonology review asthma review  Gabapentin worked for chronic cough    thank goodness, something did (RCT)

Chronic cough is the scourge both of the coughers themselves, and the doctors who treat them. Although rarely medically serious, chronic cough can be surprisingly debilitating by disrupting sufferers’ social and professional lives — church, piano recitals, and business meetings are a few situations that involuntary coughing can mess with your mojo. Doctors, for their part, often feel frustrated and powerless in treating chronic cough. Although gastroesophageal reflux disease (GERD), asthma, ACE inhibitor use, and post-nasal drip (upper airway cough syndrome) are the most common causes, there is no reliable test to identify the cause of chronic cough, and many patients do not respond to therapies for these conditions. Antitussives usually don’t work either, although slow-release morphine seems to.

Experiments demonstrate that in people with chronic cough, the cough reflex is excessively sensitive — they cough in response to to irritants or stimuli that wouldn’t bother most people. Investigators Nicole Ryan, Surrinder Birring, and Peter Gibson suspected similar mechanisms might operate in chronic cough and neuropathic pain — in which “central” brain factors amplify the sensitivity to noxious stimuli. Gabapentin (Neurontin) has been shown efficacious in neuropathic pain; could it improve chronic cough? They report their results in the August 27 Lancet, online.

What They Did

Authors enrolled a mere 62 patients with refractory chronic cough at a single clinic in Australia. All patients had had cough for at least 8 weeks, and had failed management with empiric therapies for the usual etiologies. Participants were randomized to receive either gabapentin (at 600 mg t.i.d. if tolerated) or placebo for 10 weeks. They wore microphones for 1 hour at various periods to record their cough frequency. The primary endpoint was the change in quality of life due to cough (the Leicester cough questionnaire score) after 8 weeks of therapy. Ten patients dropped out (roughly equal between groups); 52 completed the study.

What They Found

A 1.3 point change in the cough questionnaire QOL score is considered clinically meaningful (from validation studies). More patients taking gabapentin (74%) compared to placebo (46%) met the primary endpoint, i.e., had improved quality of life related to their cough. They also had reduced cough severity.

However, there was evidence for a negative rebound effect. After treatment was stopped, people in the gabapentin group had their coughs return with greater severity (on a visual analog scale), and had even greater cough reflex sensitivity than they did before entering the trial (measured by cough from inhaled capsaicin using standardized, validated methods). However, they didn’t complain of worse cough related quality of life after stopping treatment.

The trial was too small to meaningfully test differences in side effects / adverse events, but there was no difference and gabapentin was considered to be well-tolerated.

What It Means

Frustrated patients and their doctors now have something reasonable to try (besides morphine) to soothe the symptoms of chronic cough, after empiric treatments for the common causes have failed. However, as the authors acknowledge, the results of this small, single center trial could also be due to an “active placebo effect.” Gabapentin has significant central nervous system effects — in other words, you feel it when you take it. In that sense, this trial was not blinded, as many patients surely knew they were taking “the good stuff” and may have responded to that. The fact that almost half of participants had significant improvement in their symptoms over time was also encouraging, and should be emphasized when counseling patients. There’s little financial incentive for a large randomized trial testing gabapentin for chronic cough, but pulmonologists and patients would celebrate if this therapy — or any therapy — proved effective.

Ryan NM et al. Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet August 27, 2012 ePub online.

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  12 Responses to “Gabapentin worked for chronic cough — thank goodness, something did (RCT)”

  1. Please help me I have this cough for over 15years went to doctors in NYC and mayo nobody knows what to due mucos is thick cough is horrible I am 64 and do not know what else to do I live in az.

  2. I have had my cough for over 15 years as well, I have tried numerous ENTs, naturopaths, doctors, acupuncture, Chinese medicine, physicians, asthma challenge tests, lung function tests, 24hour acid monitor (tube through nose to stomach), barium swallow scans, the amount of antibiotics I have had is just crazy, prednisone, antacids, nose sprays, cortisone, lyrica, lung biopsy, speech therapy, various vitamins & supplements, elimination diets & I don’t want to think of how much this has cost!
    I have been told that it may be post nasal drip, under developed sinus passages, hyper sensitive vocal cords from chronic cough, haemophilus influenza bug from lung biopsy, one speech therapist told me just learn to cope with it as it’s not going to kill you!
    I am now starting on gabapentin to see if I can get some relief. My cough also effects my family as I keep them awake at night & my next door neighbour can also hear me.
    I know chronic cough is not life threatening but it is very draining, causes headaches, rib & back pain & embarrassing. I have had an elderly lady in a gofer on oxygen offer me lozenges as I’m having a coughing fit with tears running down my face, I felt so stupid because she is really sick & I just have a chronic pain in the arse cough!
    If anyone has any suggestions as to what else I can try, I would be extremely greatful, I have my fingers crossed that the gabapentin will help but it doesn’t sound like its a long term cure.
    I live in country Victoria – Australia

    • I’ve had a chronic cough for 3 years. Started Gabapentin 10 months ago. It has greatly improved my life because I had PHN and the Gabapentin has been healing the nerves. I take 5 x 400mg, anything less is not as effective. Coughing is serious because, as I found out, it damages your pelvic floor and core muscles. I have gentle exercises to do and must rest, or my cough is worse. If I had a job, I would have to quit. The reason I got shingles in the first place was because I have Adrenal Fatigue, again, not diagnosed until 3 months ago. Reflexology has been of great benefit to me also.

  3. i no what your going through i have been coughing for over twenty years testapon test nothing helped started gabapentin seven weeks ago one three times aday 100mg tablet up to now its not helping just gaining weight. good luck. chrisie. london england.

    • I think your dose is too low, I started on that dose, but moved it up to 5 x 400mg PD and find this very helpful, am able to go out at least. I also have Adrenal Fatigue and think they’re related. When I get tired I cough more.

  4. I’ve had a chronic cough for 5 years, I was on cymbalta (anti-despressant) for about 3 4 months, that controlled it to a hmm himm but I hated the brain fog so I stopped – cough came back. My doctor wouldn’t let me go valium or some stronger codine based med. I asked to try gabapentin once I heard about it. I am now on the full dose of gabapentin (600 mg pd), this is the first week of 4 months. So far it is controlling my cough. It hasn’t gone completely, but I don’t cough from just breathing! I am in Australia and it is now costing me about $60 – $100 a month – so far great.. don’t know what will happen once I go off it.

  5. From the management: The comments posted here constitute conversation between laypeople. They are not medical advice from any physician. Don’t start, stop or change any therapy without talking with your doctor. This is language I need to post here for legal reasons, thanks.

    • Please educate the doctors. I had to diagnose myself, by researching the internet. I had a great life and it was taken away from me, that’s why I wouldn’t give up even after 7 specialists told me there was nothing wrong with me. I also thought alternative medicine was a form of voodoo. In my desperation to try anything, I gave reflexology a go. The single most harmless and helpful thing I have ever tried in my life. I had to convince my GP that the Gabapentin was worth trying as I was desperate. After the GP did his research, he agreed with me.

  6. I have been coughing for 8 years and my quality of life was deteriorating. I didn’t want to subject people to all the noise and it was embarrassing too. I was about to give up hope when I came upon something called sensory neuropathic cough and a Dr. Robert Bastian in Illinois. His 20 minute video I found on the internet was so informative and it was as if he was speaking to me and my problem. I took the info I learned to an ENT in Oklahoma City and he said he wanted me to try Gabapentin which is an anti-seizure drug. I was a little skeptical but desperate to try this new approach. It quiets the nerves in the back of my throat and within a couple of days I was hardly coughing at all. This has been the most wonderful thing that has changed my life. I never thought taking a pill was going to be a solution. There is hope!!

    • Hi Sally, glad I found this site. Thinking of going onto Gabapentin myself, same problem as everyone else 18 year old cough, I’m a very fit (gym bunny) 54 year old, and am very nervous about the said side effects. My specialist in UK Professor Ian Pavord (Oxford Uni) has recommended 300mg a day building up to 300 x 3 a day. Can you tell me how well you’re doing on it now several months later or can anyone tell me how they’ve found this drug in that quantity and secondly, has anyone come off it due to side effects and how did you feel? Finally does anyone know when one comes off the drug whether there are lasting effects to the body such as weight gain, mood change or even worsened cough? Of course I can ask the doctors, but frankly like Lindi above I have more faith in my self diagnosis as I know my body better than they do (at least to a large part).

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