Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota.
JAMA Otolaryngol Head Neck Surg. 2016 Sep 1;142(9):881-8. doi: 10.1001/jamaoto.2016.0972.
Refractory chronic cough is a debilitating condition with limited therapeutic options. Laryngeal botulinum toxin type A (BtxA) has been anecdotally reported to benefit patients with chronic cough. We report on our experience with the use of BtxA for the treatment of patients with refractory chronic cough.
To describe the effects of electromyography (EMG)-guided thyroarytenoid (TA) BtxA injection for the treatment of refractory chronic cough.
DESIGN, SETTING, AND PARTICIPANTS: For this single tertiary referral center retrospective case series, we included all patients with refractory chronic cough who received bilateral EMG-guided TA BtxA injections (n = 22) between July 1, 2013, and July 31, 2014, at the Mayo Clinic in Rochester, Minnesota.
Bilateral TA BtxA injection.
The primary outcome is a self-reported improvement of 50% or more in cough severity and/or symptoms by a 2-month follow-up telephone call. Adverse events and patient-reported quality measures were also assessed.
A total of 22 patients (median [interquartile range] age 61 [57.5-85] years; 19 of 22 women) underwent 31 distinct laryngeal BtxA treatment sessions. The primary outcome of self-reported improvement of 50% or more of cough severity and/or symptoms was achieved in 16 of 31 (52%) treatment sessions. Eleven patients (50%) reported greater than 50% improvement after the first BtxA injection. No major complications occurred. Postprocedural liquid dysphagia had a positive predictive value of 84% and negative predictive value of 100% for response to therapy.
In this case series, laryngeal BtxA injection was well tolerated in patients with refractory chronic cough with half of participants experiencing at least short-term improvement in their cough. The occurrence of liquid dysphagia after a BtxA injection appeared to be predictive of a beneficial response. The durability of response, patient selection criteria, and optimal BtxA dosage remains to be determined.
难治性慢性咳嗽是一种使人虚弱的疾病，治疗选择有限。喉肌内注射肉毒毒素 A（BtxA）已被报道对慢性咳嗽患者有益。我们报告了使用 BtxA 治疗难治性慢性咳嗽患者的经验。
描述肌电图（EMG）引导杓状软骨肌（TA）BtxA 注射治疗难治性慢性咳嗽的效果。
设计、地点和参与者：这项单中心回顾性病例系列研究包括 2013 年 7 月 1 日至 2014 年 7 月 31 日期间在明尼苏达州罗切斯特市梅奥诊所接受双侧 EMG 引导 TA BtxA 注射治疗的难治性慢性咳嗽患者（n=22）。
双侧 TA BtxA 注射。
主要结果是通过 2 个月的随访电话报告咳嗽严重程度和/或症状改善 50%或更多。还评估了不良事件和患者报告的质量指标。
共 22 例患者（中位数[四分位距]年龄 61 [57.5-85]岁；22 例患者中有 19 例女性）接受了 31 次单独的喉部 BtxA 治疗。31 次治疗中，有 16 次（52%）报告咳嗽严重程度和/或症状改善 50%或更多。首次 BtxA 注射后，11 例患者（50%）报告改善超过 50%。无重大并发症发生。术后液体吞咽困难对治疗反应的阳性预测值为 84%，阴性预测值为 100%。
在本病例系列研究中，难治性慢性咳嗽患者对喉 BtxA 注射耐受性良好，半数患者咳嗽至少有短期改善。BtxA 注射后发生液体吞咽困难似乎与有益反应相关。反应的持久性、患者选择标准和最佳 BtxA 剂量仍有待确定。
