Amador Rafael, Goebel Russell, Noordzij Jacob Pieter, Bhatt Neel K, Cohen Seth, Daniels Kadesh, Tracy Lauren, Yajima Masanao, Krisciunas Gintas P
Department of Otolaryngology, Boston Medical Center, Boston, MA 02118, United States of America.
Department of Mathematics and Statistics, Boston University, Boston 02215, United States of America.
Am J Otolaryngol. 2023 May-Jun;44(3):103815. doi: 10.1016/j.amjoto.2023.103815. Epub 2023 Feb 25.
Chronic laryngitis can present with numerous symptoms, including chronic cough. Patients who do not respond to standard treatment are sometimes diagnosed with chronic airway hypersensitivity (CAH). In many centers, neuromodulators are prescribed off-label despite limited evidence of efficacy. A previous meta-analysis suggested neuromodulator therapy improved cough-related quality-of-life (QoL). This current updated and expanded meta-analysis examined whether neuromodulators reduced cough frequency, reduced cough severity, and/or improved QoL in CAH patients.
PubMed, Embase, Medline, Cochrane Review, and publication bibliographies were searched from 01/01/2000 to 07/31/2021 using MESH terms.
PRISMA guidelines were followed. 999 abstracts were identified/screened, 28 studies were fully reviewed, and 3 met inclusion criteria. Only randomized controlled trials (RCT) investigating CAH patients with comparable cough-related outcomes were included. Three authors reviewed potentially eligible papers. Fixed-effect models and calculated pooled estimates using the Inverse-Variance method were used.
The estimated difference in change in log coughs per hour (from baseline to intervention end) between treatment and control groups was -0.46, 95%CI [-0.97; 0.05]. Estimated change-from-baseline in VAS scores was -12.24, 95 % CI [-17.84; -6.65] lower for patients who received treatment vs placebo. Estimated change-from-baseline for LCQ scores was 2.15, 95 % CI [1.49-2.80] higher for patients who receive treatment vs placebo. Only change in LCQ score was clinically significant.
This study tentatively suggests that neuromodulators have the potential to reduce cough symptoms associated with CAH. However, high-quality evidence is lacking. This could be due to limited treatment effect or significant limitations in the design and comparability of existing trials. A well-designed and properly powered RCT is needed to authoritatively test the efficacy of neuromodulators for the treatment of CAH.
Level I, evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.
慢性喉炎可表现出多种症状，包括慢性咳嗽。对标准治疗无反应的患者有时被诊断为慢性气道高敏反应（CAH）。在许多中心，尽管疗效证据有限，但仍超适应证使用神经调节剂。先前的一项荟萃分析表明，神经调节剂疗法可改善与咳嗽相关的生活质量（QoL）。本次更新并扩展的荟萃分析探讨了神经调节剂是否能降低CAH患者的咳嗽频率、减轻咳嗽严重程度和/或改善生活质量。
使用医学主题词从2000年1月1日至2021年7月31日检索了PubMed、Embase、Medline、Cochrane综述和出版物参考文献。
遵循PRISMA指南。共识别/筛选了999篇摘要，对28项研究进行了全面审查，其中3项符合纳入标准。仅纳入了调查具有可比咳嗽相关结局的CAH患者的随机对照试验（RCT）。三位作者对可能符合条件的论文进行了审查。采用固定效应模型，并使用逆方差法计算合并估计值。
治疗组与对照组每小时咳嗽次数变化（从基线至干预结束）的估计差异为-0.46，95%置信区间[-0.97；0.05]。接受治疗的患者与安慰剂组相比，视觉模拟量表（VAS）评分从基线的估计变化低12.24，95%置信区间[-17.84；-6.65]。接受治疗的患者与安慰剂组相比，咳嗽生活质量问卷（LCQ）评分从基线的估计变化高2.15，95%置信区间[1.49 - 2.80]。只有LCQ评分的变化具有临床意义。
本研究初步表明，神经调节剂有可能减轻与CAH相关的咳嗽症状。然而，缺乏高质量证据。这可能是由于治疗效果有限或现有试验在设计和可比性方面存在重大局限性。需要进行设计良好且样本量充足的RCT，以权威地检验神经调节剂治疗CAH的疗效。
I级，来自对所有相关RCT（随机对照试验）的系统评价或荟萃分析的证据，或基于对RCT的系统评价或三项或更多高质量且结果相似的RCT的循证临床实践指南的证据。
