Emerging treatments

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Aanhoudende hoest bij kinderen in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2017La toux prolongée chez l’enfant en première ligne de soinsPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017

Opioids

One randomized double-blind placebo-controlled trial found that low-dose morphine resulted in a significantly greater improvement in cough-specific quality of life compared with placebo in patients with refractory chronic cough.[57] Constipation is a major adverse effect. Guidelines conflict in whether they recommend opioids for chronic cough.[52][58]​​

Gabapentin

One randomized, double-blind trial found that gabapentin significantly improved cough-specific quality of life compared with placebo.[59] Gabapentin has been advocated in the management of refractory chronic cough, but clinical experience suggests that its use may be limited by adverse effects.[3][52]​​

Gefapixant

Gefapixant, an oral P2X3 receptor antagonist, significantly reduced 24-hour cough frequency compared with placebo (at 12 and 24 weeks) in two large double-blind, randomized, parallel-group studies (COUGH-1 and COUGH-2) of patients with refractory chronic cough or unexplained chronic cough.​​[60] In a meta-analysis of nine randomized phase 2 and 3 clinical trials (including COUGH-1 and COUGH-2), use of gefapixant resulted in modest improvements in cough symptoms and quality of life compared with placebo.​​​​[61] The meta-analysis also found increased taste-related adverse events with gefapixant compared with placebo. Gefapixant is approved by the European Medicines Agency (EMA) for the treatment of refractory or unexplained chronic cough. However, the Food and Drug Administration (FDA) declined to approve gefapixant for this indication as they determined it did not meet substantial evidence of effectiveness.

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