Inhaled corticosteroids for subacute and chronic cough in adults

Abstract

BackgroundPersistent cough is a common clinical problem. Despite thorough investigation and empirical management, a considerable proportion of those people with subacute and chronic cough have unexplained cough, for which treatment options are limited. While current guidelines recommend inhaled corticosteroids (ICS), the research evidence for this intervention is conflicting. ObjectivesTo assess the effects of ICS for subacute and chronic cough in adults. Search methodsWe searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and ClinicalTrials.gov in December 2012 and conducted handsearches. Selection criteriaTwo authors independently assessed all potentially relevant trials. All published and unpublished randomised comparisons of ICS versus placebo in adults with subacute or chronic cough were included. Participants with known chronic respiratory disease and asthma were excluded. Studies of cough-variant asthma and eosinophilic bronchitis were eligible. Data collection and analysisTwo authors independently extracted data pertaining to pre-defined outcomes. The primary outcome was the proportion of participants with clinical cure or significant improvement (over 70% reduction in cough severity measure) at follow up (clinical success). The secondary outcomes included proportion of participants with clinical cure or over 50% reduction in cough severity measure at follow up, mean change in cough severity measures, complications of cough, biomarkers of inflammation and adverse effects. We requested additional data from study authors.1 Inhaled corticosteroids for subacute and chronic cough in adults (Review)

Treatment of Unexplained Chronic Cough

“…Johnstone et al 33 performed a systematic review to assess whether ICS could cure UCC in adults. Eight eligible RCTs were identified involving 570 participants.…”

“…23,27,29 One study used several labels concurrently within the same article 25 (treatment-resistant, idiopathic, and intractable). The systematic reviews used the terms refractory, [30][31][32] unexplained, 31,33 and idiopathic cough.…”

Management of chronic refractory cough

“…20 98 A systematic review to assess whether inhaled corticosteroids could result in cure of chronic unexplained cough in adults identified eight eligible RCTs with 570 participants. 99 The studies were of good quality but were heterogeneous in terms of cough duration (fewer than three weeks to more than eight weeks) and the exclusion of other cough related conditions. Treatment with inhaled corticosteroids significantly reduced cough score but analysis of the primary outcome (cure) was not possible because of study heterogeneity.…”

Tos en otorrinolaringología: Revisión actualizada del enfoque clínico

“…Luego del metaanálisis se concluye que los CIN producen una disminución significativa en el manejo sintomático de la tos, sin embargo, la calidad de la evidencia es baja 58 .…”