Inhaled corticosteroids for subacute and chronic cough in adults (Review)

Kate Johnstone, Anne Chang, Kwun Fong, Rayleen Bowman, Ian Yang

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    Background: Persistent cough is a common clinical problem. Despite thorough investigation and empirical management, a considerable proportionof those people with subacute and chronic cough have unexplained cough, for which treatment options are limited. While currentguidelines recommend inhaled corticosteroids (ICS), the research evidence for this intervention is conflicting.

    Objectives: To assess the effects of ICS for subacute and chronic cough in adults.

    Search methods: We searched the Cochrane Airways Group Register of Trials, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASEand in December 2012 and conducted handsearches.

    Selection criteria: Two authors independently assessed all potentially relevant trials. All published and unpublished randomised comparisons of ICS versusplacebo in adults with subacute or chronic cough were included. Participants with known chronic respiratory disease and asthma wereexcluded. Studies of cough-variant asthma and eosinophilic bronchitis were eligible.

    Data collection and analysis: Two authors independently extracted data pertaining to pre-defined outcomes. The primary outcome was the proportion of participantswith clinical cure or significant improvement (over 70% reduction in cough severity measure) at follow up (clinical success). Thesecondary outcomes included proportion of participants with clinical cure or over 50% reduction in cough severity measure at followup, mean change in cough severity measures, complications of cough, biomarkers of inflammation and adverse effects. We requestedadditional data from study authors.

    Main results: Eight primary studies, including 570 participants, were included. The overall methodological quality of studies was good. Significantclinical heterogeneity resulting from differences in participants and interventions, as well as variation in outcome measures, limitedthe validity of comparisons between studies for most outcomes. Data for the primary outcome of clinical cure or significant (> 70%)improvementwere available for only three studies,which were too heterogeneous to pool. Similarly, heterogeneity in study characteristicslimited the validity of meta-analysis for the secondary outcomes of proportion of participants with clinical cure or over 50% reductionin cough severity measure and clinical cure. One parallel group trial of chronic cough which identified a significant treatment effectcontributed themajority of statistical heterogeneity for these outcomes. While ICS treatment resulted in amean decrease in cough scoreof 0.34 standard deviations (SMD -0.34; 95% CI -0.56 to -0.13; 346 participants), the quality of evidence was low. Heterogeneity alsoprevented meta-analysis for the outcome of mean change in visual analogue scale score.Meta-analysis was not possible for the outcomesof pulmonary function, complications of cough or biomarkers of inflammation due to insufficient data. There was moderate qualityevidence that treatment with ICS did not significantly increase the odds of experiencing an adverse event (OR 1.67; 95% CI 0.92 to3.04).
    Original languageEnglish
    Article number CD00930
    Pages (from-to)1-85
    Number of pages85
    JournalCochrane Database of Systematic Reviews
    Issue number3
    Publication statusPublished - 28 Mar 2013


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