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Original Research: Signs and Symptoms of Chest Diseases |

Efficacy and Tolerability of Treatments for Chronic CoughTreatments for Chronic Cough: A Systematic Review and Meta-analysis

William S. Yancy, Jr, MD, MHSc; Douglas C. McCrory, MD, MHS; Remy R. Coeytaux, MD, PhD; Kristine M. Schmit, MD, MPH; Alex R. Kemper, MD, MPH; Adam Goode, PhD, PT, DPT; Victor Hasselblad, PhD; Brooke L. Heidenfelder, PhD; Gillian D. Sanders, PhD
Author and Funding Information

From the Department of Medicine (Drs Yancy, McCrory, and Sanders), Doctor of Physical Therapy Division (Drs Coeytaux and Goode), Department of Community and Family Medicine (Dr Schmit), Department of Pediatrics (Dr Kemper), and Department of Biostatistics & Bioinformatics (Dr Hasselblad), Duke University School of Medicine; Center for Health Services Research in Primary Care (Drs Yancy and McCrory), Veterans Affairs Medical Center; and Duke Evidence-based Practice Center (Drs McCrory, Coeytaux, Heidenfelder, and Sanders), Duke Clinical Research Institute, Durham, NC.

Correspondence to: William S. Yancy Jr, MD, MHSc, VA Medical Center (152), 508 Fulton St, Durham, NC 27705; e-mail: yancy006@mc.duke.edu


Funding/Support: This project was funded by the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services [Contract 290-2007-10066-I]. Dr Goode is supported by the AHRQ K-12 Comparative Effectiveness Career Development Award [Grant HS19479-01].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(6):1827-1838. doi:10.1378/chest.13-0490
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Background:  Understanding the comparative effectiveness of treatments for patients with unexplained or refractory cough is important to increase awareness of proven therapies and their potential adverse effects in this unique population.

Methods:  We performed a literature search for English-language studies published up to June 2012 that compared symptomatic therapies for chronic cough. Two investigators screened each abstract and full-text article for inclusion, abstracted data, and rated quality. Meta-analysis with random-effects models was used to summarize effects of treatments.

Results:  We identified 49 studies (3,067 patients) comprising 68 therapeutic comparisons. Of the studied agents, opioid and certain nonopioid and nonanesthetic antitussives had demonstrated efficacy for chronic cough in adults. Compared with placebo, effect sizes (standardized mean differences for cough severity and rate ratios for cough frequency) for opioids were 0.55 (95% CI, 0.38-0.72; P < .0001) and 0.57 (95% CI, 0.36-0.91; P = .0260), respectively. For dextromethorphan, effect sizes were 0.37 (95% CI, 0.19-0.56; P = .0008) and 0.40 (95% CI, 0.18-0.85; P = .0248), respectively. The overall strength of evidence was limited by inconsistency and imprecision of results and by small numbers of direct comparisons. Nonpharmacologic therapies and the management of cough in children were infrequently studied.

Conclusions:  Although evidence is limited, opioid and certain nonopioid and nonanesthetic antitussives demonstrated efficacy for treating chronic cough in adults. There is a need for further studies in patients with unexplained or refractory cough as well as for more systematic study designs, assessment of patient-centered outcomes, and reporting.

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