Pay attention to standardized diagnosis and treatment of corticosteroid-responsive cough

The global prevalence of chronic cough in adults is 9.6%.In 2008, the cough special issue of Lancet published a diagnosis and treatment plan to distinguish the causes of chronic cough based on eosinophilic airway inflammation or sensitivity to glucocorticoids therapy. In 2014, Professor Lai Kefang of China first proposed the Chinese name “corticosteroid-responsive cough” (CRC). CRC refers to chronic cough that is effectively treated with glucocorticoids, accounting for 63% of the causes of chronic cough in China, including cough variant asthma, eosinophilic bronchitis, and atopic cough. Cough variant asthma is the most common cause of chronic cough in China, accounting for 30% to 50% Chronic cough has a complex etiology and involves numerous examinations, especially bronchial provocation tests, induced sputum cell analysis, multi-channel esophageal impedance pH monitoring, etc., which have not been carried out in many tertiary hospitals, and not all chronic patients can undergo relevant examinations to confirm diagnosis and receive treatment. The concept of corticosteroid-responsive cough has important guiding significance for the empirical treatment of chronic cough, and is suitable for promotion in grassroots hospitals. In clinical practice, it is only necessary to determine whether it is a CRC based on the clinical characteristics of the patient without the need for further tests, such as induced sputum cell analysis and bronchial provocation tests to distinguish cough variant asthma, eosinophilic bronchitis, and allergic cough, and then empirical treatment can be given. However, there is currently insufficient understanding of the standardized diagnosis and treatment of CRC. For example, there is still a lack of consensus on determining whether it is CRC, how to select hormone treatment and the duration of hormone treatment. It is necessary to further emphasize and promote the relevant concepts and diagnosis and treatment plans of corticosteroid-responsive cough

A randomized, double-blinded, placebo-controlled clinical trial of duloxetine hydrochloride enteric-coated tablets in the treatment of refractory chronic cough

Abstract Introduction Refractory cough, a chronic cough with an unclear diagnosis or poor treatment response. The symptoms are often stubborn and persistent, causing serious complications and lowering the patient's quality of life. Cough hypersensitivity syndrome (CHS) is proposed as a potential cause, and reducing sensory nerve hyperresponsiveness is suggested as an effective treatment. However, current drugs have low efficacy and benefit rates and numerous side effects. This trail proposes using duloxetine, a selective 5-HT and norepinephrine reuptake inhibitor, as a potential treatment for refractory cough, which has shown promise in treating pain and depression. Duloxetine may inhibit pain conduction and oxidative stress in peripheral nerves by inhibiting the activity of TRPV1 channels, which play an important role in the peripheral afferent pathway of refractory cough. Meanwhile, the antidepressant effects of duloxetine may also play a role in the treatment of refractory cough. Methods and analysis This is a single-center, prospective, randomized, double-blind, and controlled trial. A total of 98 individuals will be randomized in a 1:1 ratio to duloxetine group and placebo control group (starting with 20 mg QD, increasing 20 mg daily until 20 mg TID). After a screening period, the second stage runs from baseline to the 42nd (last) day of treatment, with follow-up visits on the 3rd, 7th, 14th, 21st, 28th, 35th, 42nd and 49th days. The main end-stage observation indicators include objective cough frequency, cough visual analog scale (VAS), cough symptom score, Leicester Cough Questionnaire (LCQ), and cough evaluation test (CET); the secondary end-stage observation indicators include capsaicin cough sensitivity, Patient Health Questionnaire-9 (PHQ-9), Major Depression Inventory (MDI), the Generalized Anxiety Disorder-7 scale (GAD-7), Life Events Scale (LES-32), induced sputum supernatant. The safety measures will be AEs/SAEs, vital signs, liver and kidney function, fecal occult blood test. Discussion This study is the first randomized, double-blind, and controlled clinical trial investigating the use of duloxetine in the treatment of refractory coughs. The study aims to provide a high-quality basis for evaluating the efficacy and safety of duloxetine for this condition. Trial registration Our study was registered in the Chinese Clinical Trials Register ( www.chictr.org.cn/ ) (ChiCTR2000037429) in 28/08/2020

Additional file 1 of Positive effect of deep diaphragmatic breathing training on gastroesophageal reflux-induced chronic cough: a clinical randomized controlled study

Supplementary Material