a Clinical Toxicology Research Group, School of Medicine and Public Health , The University of Newcastle, Calvary Mater Hospital , Newcastle , Australia.
b Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health , Hunter Medical Research Institute, The University of Newcastle , Newcastle , Australia.
Expert Opin Pharmacother. 2018 May;19(7):687-711. doi: 10.1080/14656566.2018.1462795. Epub 2018 Apr 16.
Chronic Cough (CC) is common and often associated with significant comorbidity and decreased quality of life. In up to 50% of cases, the cough is refractory despite extensive investigation and treatment trials. It is likely that the key abnormality in refractory CC is dysfunctional, hypersensitive sensory nerves, similar to conditions such as laryngeal hypersensitivity and neuropathic pain.
The aim of this systematic review is to assess drug therapies for refractory CC. The authors review the current management of CC and provide discussion of the similarities between neuropathic pain and refractory CC. They review repurposed and new pharmacological treatments. Several meta-analyses were performed to compare the efficacy of treatments where possible.
Repurposed pain medications such as gabapentin and pregabalin reduce the frequency of cough and improve quality of life. Along with speech pathology, they are important and alternate treatments for refractory CC. However, more treatments are needed and the P2X3 ion channel receptor antagonists show the most promise. With a better understanding of neuronal activation and sensitisation and their signal processing in the brain, improved animal models of cough, and the use of validated cough measurement tools, more effective treatments will develop.
慢性咳嗽（CC）很常见，常伴有严重的合并症和生活质量下降。在多达 50%的病例中，尽管进行了广泛的调查和治疗试验，咳嗽仍然顽固难治。在难治性 CC 中，功能失调的、超敏的感觉神经很可能是关键异常，类似于喉超敏反应和神经病理性疼痛等情况。
本系统评价旨在评估难治性 CC 的药物治疗。作者回顾了 CC 的当前治疗方法，并讨论了神经病理性疼痛和难治性 CC 之间的相似之处。他们回顾了已重新应用和新的药理学治疗方法。在可能的情况下，对几种治疗方法进行了荟萃分析以比较疗效。
重新应用的止痛药物，如加巴喷丁和普瑞巴林，可减少咳嗽频率并提高生活质量。与言语病理学一起，它们是难治性 CC 的重要替代治疗方法。然而，还需要更多的治疗方法，P2X3 离子通道受体拮抗剂显示出最大的前景。随着对神经元激活和致敏及其在大脑中的信号处理的更好理解，以及使用经过验证的咳嗽测量工具，将开发出更有效的治疗方法。
