Chronic Cough by Thomas L. Carroll;

Author:Thomas L. Carroll; [Carroll, Thomas L.]
Language: eng
Format: epub
Publisher: Plural Publishing Inc.
Published: 2019-08-15T00:00:00+00:00

LEMG = Laryngeal electromyography.

*Proportion difference reported without statistical evaluation.

TREATMENT

Once the diagnosis of neurogenic cough is clinically suspected, randomized controlled trials have shown that the use of neuromodulating medications can improve cough severity8, 31, 32 and cough-related quality of life.8, 31, 32 Neuromodulators with level 1 evidence include gabapentin, amitriptyline, and pregabalin.8, 31, 32 Other agents, including tramadol and baclofen, have been used with success.33, 34 In addition, cough retraining therapy by a trained speech-language pathologist may play a role in treatment and maintaining effective treatment, as discussed in Chapter 8.31 A number of questions remain around the treatment of chronic cough with neuromodulators, including: what is the most effective agent, what are the optimal dose/titration regimens (Table 6–2), what are adequate lengths for therapy, and what are the long-term outcomes. Following a review of the literature on specific agents, this chapter will answer these questions.

Motor Neuropathy and Choosing the Diagnostic Modality

Amitriptyline

Amitriptyline is a tricyclic antidepressant (TCA) that mainly inhibits both serotonin and norepinephrine reuptake but may weakly interact with several other receptors including opioid, adenosine, α2-adrenergic, NMDA, nicotinic, cholinergic, and histaminergic receptors.35 With respect to TCAs, amitriptyline also has prominent anticholinergic effects, which should be considered in elderly patients. In the prospective studies listed in Table 6–2, amitriptyline has been shown to improve cough symptoms in 75% to 83% of patients. A randomized placebo-controlled trial conducted by Jeyakumar et al (2006) demonstrated significant improvement in cough severity and cough-related quality of life with a 10-day course.8

Table 6–2. Reported Neuromodulator Dosing Regimens

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