title: Pregabalin and Speech Pathology Combination Therapy for Refractory Chronic Cough: A Randomized Controlled Trial.
abstract: BACKGROUND
  Chronic refractory cough (CRC) is a difficult problem to treat. Speech pathology treatment (SPT) improves symptoms but resolution is incomplete. Centrally acting neuromodulators also improve cough symptoms, but not cough reflex sensitivity, and the effect is short-lived. We hypothesized that combined SPT and centrally acting neuromodulators would have a superior outcome than SPT alone. Our goal was to determine whether combined pregabalin and SPT is more effective than SPT alone.
  
  
  METHODS
  Randomized placebo controlled trial. Forty patients with CRC were randomly assigned to receive either combined SPT and pregabalin 300 mg daily or combined SPT and placebo. Outcome measures were collected at baseline, end of treatment, and 4 weeks after the end of treatment. Primary outcome measures were cough frequency using the Leicester Cough Monitor, cough severity using a visual analog scale (coughVAS), and cough-related quality of life (QOL) using the Leicester Cough Questionnaire (LCQ).
  
  
  RESULTS
  Cough severity, cough frequency, and cough QOL improved in both groups. The degree of improvement in LCQ and coughVAS was greater with combined SPT and pregabalin than SPT alone; the mean difference in LCQ was 3.5, 95%CI of difference 1.1 to 5.8; the mean difference in coughVAS was 25.1, 95% CI of difference 10.6 to 39.6. There was no significant difference in improvement in cough frequency between groups. There was no deterioration in symptoms once pregabalin was withdrawn. Median capsaicin cough sensitivity improved from 15.7 to 47.5 μM with combined SPT and pregabalin and from 3.92 to 15.7 μM with SPT alone.
  
  
  CONCLUSIONS
  Combined SPT and pregabalin reduces symptoms and improves QOL compared with SPT alone in patients with CRC.
authors.affiliation: Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, Australia. Electronic address: anne.vertigan@hnehealth.nsw.gov.au.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Vertigan
authors.affiliation: Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Kapela
authors.affiliation: Department of Toxicology & Pharmacology, The University of Newcastle, Calvary Mater Newcastle, Newcastle, Australia.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ryan
authors.affiliation: Division of Asthma, Allergy and Lung Biology, King's College Hospital, London, England.
authors.forename: Surinder S
authors.initials: SS
authors.lastname: Birring
authors.affiliation: University of Newcastle, Newcastle, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McElduff
authors.affiliation: Speech Pathology Department, John Hunter Hospital, Hunter New England Health, Newcastle, Australia; Centre for Asthma and Respiratory Diseases, School of Medicine and Public Health, Hunter Medical Research Institute, The University of Newcastle, New South Wales, Australia; University of Newcastle, Newcastle, Australia; Department of Respiratory & Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003371:Cough / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069583:Pregabalin / Q000627:therapeutic use*; D011788:Quality of Life; D012720:Severity of Illness Index; D013066:Speech-Language Pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000069583:Pregabalin
keywords: cough; dyspnea; hoarseness; vocal cord dysfunction; voice disorders