SOURCE: Vertigan AE, et al. Pregabalin and speech pathology combination therapy for refractory chronic cough: A randomized controlled trial. Chest 2016;149:639-648.
Chronic cough without an evident etiology can be a challenging issue. Guidelines suggest etiologic considerations, including infectious, allergic, malignant, mechanical, and psychological issues. In the primary care setting, recommendations call for clinicians to consider a course of antihistamines/nasal steroids, inhaled short-acting beta-agonists, and proton pump inhibitors, respectively, to rule out occult allergic rhinitis/postnasal drip, cough-variant asthma, and gastroesophageal reflux disease. Speech pathology treatment (SPT) also has been shown to be effective in refractory cases. Unfortunately, even after such inclusive treatments, a not-insubstantial group of patients continues to have unexplained cough.
Vertigan et al performed a randomized, controlled trial of SPT combined with either pregabalin (up to 300 mg/d) or placebo in patients with refractory cough (n = 44). Treatment was administered for 14 weeks, and a follow-up visit 1 month post-treatment was performed to see if treatment effects persisted after discontinuation. Outcomes included cough frequency, severity, and quality of life, using recognized metrics.
Adding pregabalin to SPT improved cough severity and quality of life better than placebo. Encouragingly, improvements in outcomes were durable at the last visit, 1 month post-treatment. Pregabalin appears to provide meaningful improvement in cough for patients who have been refractory to other standard interventions.
Pregabalin appears to provide meaningful improvement in cough for patients who have been refractory to other standard interventions.
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