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Clinical Question
Which treatments for subacute cough are effective?
Bottom line
The available evidence for treating patients with subacute cough is limited and fails to demonstrate meaningful improvements. 1a-
Reference
Study design: Systematic review
Funding: Foundation
Setting: Outpatient (any)
Synopsis
Subacute cough—defined as cough that lasts no more than 8 weeks, is not accompanied by radiographic evidence of pneumonia, and resolves on its own—is fairly common, especially following respiratory infections. These authors systematically searched PubMed and the Cochrane Central Register of Clinical Trials to identify randomized trials published in English that evaluated various treatments in patients at least 16 years old with subacute cough. The studies could have included drug and nondrug treatments, but excluded Chinese or Asian herbal remedies. They also hand-searched reference lists of included studies, relevant systematic reviews, and clinical practice guidelines. Two authors independently assessed the inclusion of studies and the risk of bias for each study. They used a third author to resolve disagreements. They were able to find only 6 trials with between 30 and 276 patients (median = 96). The studies included montelukast, inhaled albuterol (also called salbutamol) plus ipratropium, gelatin, inhaled corticosteroids (fluticasone propionate, budesonide), and opioids. Five of the studies compared treatment with placebo, one with usual care. Overall, the reporting of the studies made assessing their risk of bias difficult. The studies used a variety of cough severity scores. Although the authors identified statistically significant improvement of cough scores with some interventions, none were clinically important. Additionally, some interventions provided short-term improvement but none were sustained beyond 2 weeks. Five studies reported on adverse effects of treatment, which were mostly mild and ranged from 0% to 40% for active treatment and 0% to 27% for placebo or usual care.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Cough
Cough interferes with sleep and this is subjectively debilitating and also can impair daytime well-being and performance. Not sure these “soft” issues were addressed.