Gabapentin for refractory chronic cough

Gabapentin for
AW and JAS are named inventors on a patent describing a novel method for cough detection, clinics in Yaita (Tochigi Prefecture) and refractory chronic cough owned by University Hospital of South Manchester
and licensed to a medical device company. RA Techniques for the assessment of declares no confl icts of interest.
Rayid Abdulqawi, Ashley Woodcock, recent years, and include cough-specifi c
Respiratory Research Group, University of Manchester, Manchester M23 9LT, UK (RA, AW, JAS); disappointed that Nicole Ryan and and University Hospital of South Manchester, colleagues (Nov 3, p 1583)1 chose to Manchester, UK (AW) only collect 1 h of objective monitoring Ryan NM, Birring SS, Gibson PG. Gabapentin data in their study. We believe this is a for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet retrograde step in the design of studies 2012; 380: 1583–89.
gabapentin such as suicidal behaviour3,4 Pavord ID, Chung KF. Management of chronic cough. Lancet 2008; 371: 1375–84.
Woodcock A, Smith JA. Sex diff erences and predictors of objective cough frequency in chronic cough. Thorax 2009; 64: 393–98.
glottic-stop refl ex sensitivity in health and disease. Chest 2005; 127: 550–57.
visits, could be aff ected by the 5 Food and Drug Administration. Suicidal behavior and ideation and antiepileptic drugs. between adverse and benefi cial eff ects.
We declare that we have no confl icts of interest.
usually reported for this patient group.3 *Ken-ichiro Inoue, Hirohisa Takano We also feel we should point out We congratulate Nicole Ryan and
that capsaicin cough responses colleagues1 on their article illustrating Center for Medical Science, International University refl ect the cough refl ex pathway in its the effi cacy of gabapentin in of Health and Welfare, Ohtawara, Tochigi 324-8501, entirety and therefore cannot be used refractory chronic cough. We have Japan (KI); and Graduate School of Engineering, to diff erentiate between sensitisation some questions and comments.
Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomised, Moreover, the C5 endpoint shows to rule out whether any participants double-blind, placebo-controlled trial. Lancet such wide interperson variability that had cough-variant asthma? More 2012; 380: 1583–89.
it cannot even clearly discriminate than 70% of patients in both the 2 Anon. Mycoplasmal pneumonia as of
September 2012, Japan. IASR 2012; 33: 261–62.
health from disease.4 This variability gabapentin and placebo groups had 3 Pugh MJ, Copeland LA, Zeber JE, et al. probably explains the absence of previously been prescribed inhalers. Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans. diff erence between gabapentin and Ryan and colleagues state that “All J Am Geriatr Soc 2012; 60: 2042–47.
participants had negative responses 4 Gibbons RD, Hur K, Brown CH, Mann JJ. Finally, although gabapentin to previous investigations or trials of Gabapentin and suicide attempts.
Pharmacoepidemiol Drug Saf 2010; 19: 1241–47.
improved cough-specifi c quality of treatments for asthma”. However, it life in this study, an important out- standing question for patients and such treatments successfully at fi rst, clinicians is whether this benefi t suggesting that some cases of asthma be congratulated for increasing the outweighs the side-eff ects and risks. could have been missed. Additionally, evidence base for the treatment In 2009, the US Food and Drug Ryan and colleagues did not mention of refractory chronic cough, which Administration issued a warning5 patients’ atopic pre disposition—eg, IgE about depression and suicidal titre. This information would be useful.
Second, we wonder about the little comment on the eff ect on quality Submissions should be
taking anticonvulsants for any presence of mycoplasma-related of life as measured by the short form made via our electronic
indication. The long-term tolerability respiratory symptoms in these 36 (SF36) questionnaire. Although submission system at
and safety in refractory cough patients. Japan is experiencing a they provide persuasive evidence that
therefore remains to be established.
progressing epidemic of mycoplasma gabapentin reduced cough frequency thelancet/ Vol 381 February 23, 2013


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