Management Of Cough In Adults Research Articles

Efficacy and Safety of a Novel Gummy Formulation for the Management of Cough in Adults: Double Blind, Randomized, Placebo-Controlled Trial

The cough is one of the most common medical complaints affecting the general population. It is well known that persisting cough negatively affects subjects’ quality of life (QoL) and sleep quality. The aim of the current double blind, randomized, placebo-controlled, pilot study was to assess the effectiveness of a novel medical device in gummy format in reducing cough and improving QoL in adult subjects with acute persisting cough. Forty subjects were enrolled and randomized into two arms according to the treatment. Both the investigational product (IP) and placebo were administered orally, three times per day for 10 consecutive days. Cough symptoms and severity were measured by the Cough Clinical Score (CCS) consisting of a 6-point Likert scale, Leicester Cough Questionnaire (LCQ) and cough severity visual analogue scale (VAS). QoL was rated using the SF-36 (short form) questionnaire. Significant improvements were seen both in the daytime and nighttime cough score after 5 days and at the end of treatment in the IP group but not in those subjects taking the placebo. QoL and sleep disturbances were ameliorated significantly in the IP group only. In conclusion, IP was found safe, well-tolerated and effective in the management of persisting cough in adults.

Speech therapy in the management of difficult-to-treat chronic cough - preliminary results.

The efficacy of management of chronic cough in adults is limited. Speech therapy is one of the few therapeutic methods which seems to be useful in patients with persistent chronic cough. However, the method has not been available in Poland so far. The aim of the study was to implement speech therapy and assess its efficacy in the management of patients with difficult-to-treat chronic cough. Patients, who were diagnosed and managed due to difficult-to-treat chronic cough, were enrolled into the study. Speech therapy was developed on the basis of the technique described by Vertigan. The entire therapy consisted of eight weekly sessions, each lasting 45 minutes. Before and after speech therapy, cough severity and its impact on the quality of life was assessed by the Visual Analogue Scale (VAS) and Leicester Cough Questionnaire (LCQ). Additionally, cough challenge test with capsaicin was performed. Eighteen women were enrolled into the study, 15 of them (83%) attended all treatment sessions (median age 66 years, median duration of cough 60 months). There was a significant decrease in cough severity measured by VAS (46 vs 28 mm, p = 0.016) after completion of speech therapy. A significant improvement in patients' quality of life measured by LCQ (10.7 vs 14.6 points, p = 0.004) and an increase in the threshold of cough reflex measured by capsaicin challenge were also demonstrated. Speech therapy resulted in a decrease in cough severity and improvement of quality of life of females with refractory chronic cough. Our results support the use of speech therapy as add-on treatment in females with difficult-to-treat cough.

Speech Therapy—A Non-Pharmacological Method to Manage Difficult-to-treat Chronic Cough

Cough is the most common symptom of respiratory diseases. The results of management of chronic cough in adults are still unsatisfactory. Unexplained and difficult-to-treat chronic cough causes significant impairment in patients' quality of life. The results of recent studies suggest that speech therapy (speech language intervention) is one of the few methods which are usefull in management of persistent chronic cough. We present a case of a patient with chronic cough due to chronic nonallergic rhinitis and gastroesophageal reflux disease, who had been unsuccessfully treated for 18 years. In the patient speech therapy resulted in a significant decrease of cough severity and improvement of quality of life.

Chronic cough in adults

A cough is the single most common presenting complaint in primary care; it is a major burden on the UK economy in terms of both health care costs and lost productivity. The vast majority of these cases are an acute cough, primarily due to self-limiting upper respiratory tract infections. However, a significant proportion of the general population (between 10 and 20%) will experience chronic cough, which can have a debilitating and often overlooked impact on the patient’s quality of life. This article describes the primary care evaluation and management of chronic cough in adults, particularly when there is no obvious underlying cause, based on the recommendations of the British Thoracic Society. There is also a brief discussion regarding which cases of acute cough should be referred early before they become chronic. The article does not discuss the management of a cough in children.

The investigation and management of cough in adults

Cough is the most common reason why patients consult their doctor. An acute cough due to viral upper respiratory tract infection is disruptive to the individual and can lead to a reduction in productivity. Dextromethorphan is one of the most widely used antitussives; however, there is a paucity of evidence to support the use of antitussive medications. In some patients, the cough persists and impacts on health-related quality of life. Cough hypersensitivity syndrome (CHS) is an emerging term for patients with a chronic cough and it recognizes cough reflex hypersensitivity as a key feature. Most patients describe a laryngeal irritation, such as a tickle sensation, also known as laryngeal paraesthesia. The initial management of CHS is to minimize common aggravators, such as airway inflammation, gastro-oesophageal reflux and rhinitis, which may exacerbate a cough. In cases of refractory cough, speech- or physiotherapy-led cough suppression therapies and gabapentin are recommended. There is a pressing need to develop effective antitussive medications that target peripheral and central cough neural pathways.

Management of cough in adults

Educational aims To illustrate reasonable and cost-effective management of cough, one of the most frequent reasons for primary care consultations. To assist in the secondary care diagnosis and treatment of chronic cough as the solely presenting symptom if chest radiography and lung function tests remain inconclusive. To emphasise the rational order starting with simple (noninvasive and cost-effective) diagnostic procedures, graduating to complex, invasive and expensive ( e.g. computed tomography and bronchoscopy) measures. Summary Cough is highly prevalent as a cumbersome presenting complaint for many patients. The symptom cough is elicited by a myriad of very different respiratory and nonrespiratory diseases. Symptomatic pharmacological treatment is of very limited efficacy. Presently, no new drug for cough in the pipeline has completed phase II development. Therefore, treating cough requires exact diagnosis for causal treatment. Cough is often the first (but not necessarily an early) symptom of life-threatening diseases, such as lung tumours or recurrent pulmonary embolism. Thus, in 2004, the German Respiratory Society published evidence-based guidelines on the management of cough. Acute and chronic cough were defined, and algorithms were provided for diagnostic workup. In 2010, the guidelines were updated (http://leitlinien.net). An abridged english version is also now available [1]. In this review, evidence-based recommendations (mostly weak evidence or consensus) from these guidelines are adapted into learning points.

Pharmacological and non-pharmacological interventions for cough in adults with respiratory and non-respiratory diseases: A systematic review of the literature

The management of cough in adults with respiratory and non-respiratory illnesses is suboptimal and based mostly on clinical opinions rather than evidence. A systematic review was carried out assessing all trials in adult patients with respiratory and non-respiratory diseases (excluding cancer) that had chronic cough as primary or secondary outcome. A total of 1177 trials were retrieved and 75 met the criteria for inclusion in the review. The vast majority were in patients with asthma and chronic obstructive pulmonary disease (COPD). Cough was the primary outcome in less than one-quarter of the studies. The measurement of cough was variable, mostly using unvalidated scales or being part of an overall ‘symptoms’ score. Positive results were overall seen with the use of corticosteroids, leukotriene receptor antagonists, mast cell stabilizers, ipratropium bromide, neltenexine, iodinised glycerol and lidocaine. Speech pathology training and symptom monitoring through SMS messages (accompanied by treatment adjustments) have also shown promise. Evidence for established anti-tussive agents such as codeine was scarce, with positive studies from the 1960s, whilst more recent studies showed no effect in patients with COPD. Many studies had conflicting results. It is imperative that the management of cough and its evidence base be improved, using higher quality research designs and with cough being the primary outcome of trials.