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Because patients with chronic cough have a central hypersensitivity similar to that of neuropathic pain , gabapentin is also used to treat refractory chronic cough . Well-designed clinical trials have demonstrated that gabapentin at doses ranging from 300 to 1800 mg/day for 8 weeks significantly improves symptoms and quality of life in patients Background: Refractory chronic cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory chronic cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory chronic cough. Effective treatments for refractory chronic cough that target these areas include behavioural treatment such as speech pathology and pharmaceutical treatment with neuromodulating medications such as gabapentin. In patients with refractory chronic cough, referral to a pulmonologist or otolaryngologist should be considered, as well as a trial of gabapentin (Neurontin), pregabalin (Lyrica), or speech In The Lancet, Nicole Ryan and colleagues1 report on a placebo-controlled, double-blind trial of the effects of gabapentin—a drug used for epilepsy and neuropathic pain—on quality of life, cough frequency, and cough severity in people with chronic cough. Centrally acting neuromodulators such as amitriptyline, gabapentin, and pregabalin have been shown to improve cough and quality of life in patients with refractory cough.51–54 The effectiveness of these neuromodulators supports the increasingly prominent hypothesis of cough hypersensitivity syndrome in the pathogenesis of chronic cough. Despite recent clinical guidelines, the optimal therapeutic strategy for the management of refractory chronic cough is still a challenge. The present systematic review was designed to assess the evidence for efficacy and safety of gabapentin in the treatment of chronic cough. The most common causes of chronic cough include asthma (and other lung diseases), UACS, and GERD. Testing for these underlying conditions should be pursued before establishing a diagnosis of unexplained chronic cough. Neuromodulators have proved to be efficacious in the treatment of unexplained chronic cough and should be first-line therapy. Gabapentin is effective in the treatment of chronic refractory cough in both subjective and objective evaluations, and its safety is better than other neuromodulators. Keywords: Chronic refractory cough, Gabapentin, Meta-analysis, Efficacy, Safety. 1. Introduction. Because patients with chronic cough have a central hypersensitivity similar to that of neuropathic pain , gabapentin is also used to treat refractory chronic cough . Well-designed clinical trials have demonstrated that gabapentin at doses ranging from 300 to 1800 mg/day for 8 weeks significantly improves symptoms and quality of life in patients Results: 18 patients (mean age 60.3 yrs; 22% male; 89% Caucasian) were identified who were prescribed gabapentin for chronic cough. At baseline, all patients reported daily cough. Seventeen of 18 patients (94%) reported cough to be moderate or severe. Duration of cough prior to treatment ranged from 9 months to 20 yrs (median duration: 2 yrs). Refractory chronic cough causes substantial symptoms and quality-of-life impairment. Similarities between central reflex sensitisation in refractory chronic cough and neuropathic pain suggest that neuromodulators such as gabapentin might be effective for refractory chronic cough. Persistent cough of unexplained origin 1 is a significant health issue that occurs in up to 5% to 10% of patients seeking medical assistance for a chronic cough 2 and from 0% to 46% of patients referred to specialty cough clinics. 3-6 Patients with unexplained chronic cough (UCC) experience significant impairments in quality of life. They Effective treatments for refractory chronic cough that target these areas include behavioural treatment such as speech pathology and pharmaceutical treatment with neuromodulating medications such as gabapentin. If chronic cough persists even after treatment of the underlying disease, or if the chronic cough is not attributable to any cause, then a symptomatic approach with neuromodulators may be considered, with gabapentin as the first choice, and opioids or macrolides as alternatives. Gabapentin treatment of patients with chronic cough showed superior efficacy and a good safety record compared with placebo or standard medications. Additional randomized and controlled trials are needed.
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