Gabapentin Effective for Vagal Neuropathy-Related Chronic Cough

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Gabapentin therapy may be an effective treatment for vagal neuropathy (VN)-related chronic cough.
Gabapentin therapy may be an effective treatment for vagal neuropathy (VN)-related chronic cough.

The presence of vocal fold motion asymmetry (VFMA) is associated with a favorable response to gabapentin therapy in patients with vagal neuropathy (VN)-related chronic cough, according to findings from a retrospective study published in JAMA Otolaryngology-Head & Neck Surgery.

Investigators evaluated patients with VN-related chronic cough (n=25) who were prescribed 100 mg gabapentin twice daily for symptom relief. Therapy was titrated to adverse effects or response. A subjective report of patients' improvement of cough symptoms was used to document response to therapy.

A partial or complete response to gabapentin treatment was observed in approximately 64% (n=16) of all patients included in this cohort. According to videostroboscopy findings, investigators found the presence of VFMA in 80% of patients (n=20). In addition, the researchers observed a higher proportion of patients with VFMA who responded to gabapentin therapy compared with those with VFMA who showed no response (94% vs 56%, respectively).

The presence of VFMA differed between responders and nonresponders by 38% (95% CI, 18%-58%). Gabapentin dose was limited in 44% of nonresponders and 25% of responders because of the incidence of adverse events (odds ratio 2.5; 95% CI, 0.42-13.6).

Because this study included a relatively small sample size, the researchers were unable to determine additional associations of successful gabapentin treatment in patients with probable neurogenic cough. Subjective patient reports of cough improvement as well as the study's retrospective nature represent other limitations associated with this research.

The investigators of this study believe their findings show that the presence of VFMA on videostroboscopy represents an important clinical decision-making tool for informing “the decision to pursue gabapentin therapy” in patients with VN-related chronic cough.

Reference

Giliberto JP, Dibildox D, Merati A. Unilateral laryngoscopic findings associated with response to gabapentin in patients with chronic cough [published online September 14, 2017]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2017.1557

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