xRead - Globus and Chronic Cough (April 2024)

Wamkpah et al.

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There were 2408 patients enrolled; 2196 (91%) completed the trials. Of the 2341 patients with known sex, the majority were women (1618 patients, 69%). For studies that reported either the mean or median age of patients, most were 60–69 years old (32 studies) (Table I). Three categories of intervention were assigned: medical therapy (1857 patients, 77%, 38 studies), ST (457 patients, 19%, 9 studies), and procedural therapy (73 patients, 3%, 4 studies). One study 51 investigated both medical therapy and ST (20 patients, 1%) (Table I). Various medical therapies were prescribed: neuromodulating drugs (NMDs, i.e., gabapentin, pregabalin, baclofen), tricyclic antidepressants (TCAs), inhaled corticosteroids, opioids, macrolide antibiotics, PPIs, and investigational drugs (i.e., transient receptor potential vanilloid-1 [TRPV-1] inhibitors). Two studies included medical therapy that may be considered “alternative” or “homeopathic” medicine: oral capsaicin 50 and “trigger reduction method” (plant-based diet, reflux precautions, nasal saline irrigation, and intranasal corticosteroid or antihistamine). 58 The most commonly studied medical therapies were investigational drugs (11 studies) and gabapentin (7 studies). The median and mode duration of medical therapy was 4 and 2 weeks, respectively. Next, ST commonly involved education about the harmful impact of cough, cough suppression techniques (breathing exercises, mindfulness training, voice therapy, etc.), and stress or anxiety counseling. The median treatment duration for ST was four sessions. Finally, procedural therapies included SLN block via injection of local anesthetic (lidocaine or bupivacaine) and corticosteroid (triamcinolone acetonide or methylprednisolone), 11,46 bilateral thyroarytenoid BTX injection, 12 and vocal fold augmentation with methylcellulose or hyaluronic acid. 13 Among the studies of procedural therapy, there was a median of one treatment. Specifically for SLN block, the mean number of treatments was 2.3 11 and 2.4 46 injections. The three most commonly used cough-specific PROMs were the Leicester Cough Questionnaire (LCQ, 19 studies), 65 Cough Severity Index (CSI, 6 studies), 66 and Cough specific Quality of Life Questionnaire (CQLQ, 4 studies). 67 Only 12 studies reported voice-related outcomes (i.e., Consensus Auditory-Perceptual Evaluation of Voice, 68 Voice Handicap Index 69 ); among these studies, 10 different outcome metrics were used (Table I). The primary outcome of cough-specific QoL was analyzed first for studies reporting the most commonly used PROMs: LCQ and CSI. Next, studies dichotomizing outcomes into cough “improvement” and “no improvement” were analyzed. The secondary outcome was the proportion of patients with at least one AE. Meta-analysis was conducted for active treatments versus placebo and for active treatment groups only. Leicester Cough Questionnaire.— The LCQ is a validated, cough-specific PROM of 19 items rated on a 7-point Likert scale. The total score ranges from 3 to 21; higher scores indicate improved QoL. 65 The LCQ has a pre-/post-treatment minimal clinically important difference (MCID) score of 1.3. 70

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Meta-Analysis

Laryngoscope . Author manuscript; available in PMC 2022 January 01.