Six ways to treat persistent cough

16 Oct 2015

An expert panel have published six recommendations for treating patients with unexplained chronic cough.

The guidelines published in Chest are based on evidence from randomised trials and contain new treatment recommendations such as the use of speech pathology.

Speaking to the limbic member of the expert panel and respiratory physician Peter Gibson said that while there was more awareness around the use of speech pathology in chronic cough uptake was still limited.

Speech pathology based cough suppression extends out of voice therapy and not all speech pathologists are trained in it, he explained.

Another new treatment recommendation contained in the update guidelines include the use of neuromodulators, with the expert panel stating that the benefits in some patients outweighed the potential side effects.

“We suggest a therapeutic trial of gabapentin as long as the potential side-effects and the risk-benefit profile are discussed with patients before use of the medication, and there is a reassessment of the risk benefit profile at 6 months before continuing the drug,” the guidelines stated.

Proton pump inhibitors should also not be used in with unexplained chronic cough and a negative workup for acid gastroesophageal reflux disease, the guidelines advise.

This recommendation was potentially controversial because in some patients reflux does cause chronic cough, Professor Gibson said.

“These patients generally have symptoms of reflux and do respond to treatment but because it’s so easy to prescribe PPIs people have generalized this to say maybe it is worth trying [in all patients],” he said.

The updated guideline has been endorsed by Lung Foundation Australia, the American Academy of Otolaryngology- Head and Neck Surgery, American Association for Respiratory Care, American Thoracic Society, Irish Thoracic Society.

To read the guidelines in full click here.

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