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Signs and Symptoms of Chest Diseases: Cough |

Efficacy of Oral Specific Neuromodulators on Human Refractory Chronic Cough: A Systematic Review and Meta-analysis FREE TO VIEW

Weili Wei; Yangzi ZhangTong; Mei He; Hanjing Lv; Zhongmin Qiu
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Tongji Hospital, Tongji University School of Medicine, Shanghai, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A548. doi:10.1016/j.chest.2016.02.572
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SESSION TITLE: Cough

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 08:30 AM - 09:30 AM

PURPOSE: To evaluated the efficacy and safety of oral specific neuromodulators on refractory chronic cough.

METHODS: We assessed clinical and preclinical RCTs studies of the neuromodulating agents, baclofen, amitriptyline, gabapentin, deanxit and pregbalin, for the treatment of human cough with no restriction to language. Data were extracted from PubMed, EMBASE, LILACS, CBM, CNKI, VIP, WanFang and Cochrane Controlled Trials Register (CENTRAL) databases. Literature was searched by the two authors with a priori criteria for study selection. The outcome data were number of possible cases whose cough threshold to inhaled capsaicin C5 changed or those cough symptom improved, measured by cough or LCQ score, after treatment.

RESULTS: Three relevant articles, about three medicines of baclofen, gabepentin and amitriptyline respectively, were identified, all are randomized controlled trials. 201 persons in total were enrolled in this study all associated with specific oral centrally acting medicines. After treatment of oral centrally acting medicines the elevated effect on C5 or relief of cough symptoms was significant (risk ratio [RR]1.64; 95% CI,0.93-2.89) (Picture 1). They was well tolerated with minimal side effects. Methodological biases in the design and execution of cluster randomized trials might contributed to the selection bias in this review (Picture 2).

CONCLUSIONS: We confirm the recent observation that therapy with baclofen or gabepentin or amitriptyline decrease cough reflex sensitivity in human subjects of refractory chronic cough. Different methodological might contributed to a selection bias in our results.

CLINICAL IMPLICATIONS: To our knowledge this is the first systematic review and meta-analysis of evaluating RCTs studies of the efficacy and safety of oral specific neuromodulators on refractory chronic cough. We confirm the recent observation that therapy with baclofen or gabepentin or amitriptyline decrease cough reflex sensitivity in human subjects of refractory chronic cough. More work should be done in this area.

DISCLOSURE: The following authors have nothing to disclose: Weili Wei, Yangzi ZhangTong, Mei He, Hanjing Lv, Zhongmin Qiu

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