Gabapentin for refractory chronic cough
AW and JAS are named inventors on a patent
describing a novel method for cough detection,
clinics in Yaita (Tochigi Prefecture) and
refractory chronic cough
owned by University Hospital of South Manchester
and licensed to a medical device company. RA
Techniques for the assessment of declares no conﬂ icts of interest.
Rayid Abdulqawi, Ashley Woodcock,
recent years, and include cough-speciﬁ c
Respiratory Research Group, University of
Manchester, Manchester M23 9LT, UK (RA, AW, JAS);
disappointed that Nicole Ryan and and University Hospital of South Manchester,
colleagues (Nov 3, p 1583)1 chose to Manchester, UK (AW)
only collect 1 h of objective monitoring
Ryan NM, Birring SS, Gibson PG. Gabapentin
data in their study. We believe this is a
for refractory chronic cough: a randomised,
double-blind, placebo-controlled trial. Lancet
retrograde step in the design of studies
gabapentin such as suicidal behaviour3,4
Pavord ID, Chung KF. Management of chronic
Woodcock A, Smith JA. Sex diﬀ erences and
predictors of objective cough frequency in
chronic cough. Thorax
glottic-stop reﬂ ex sensitivity in health and
visits, could be aﬀ ected by the 5 Food and Drug Administration. Suicidal
behavior and ideation and antiepileptic drugs.
between adverse and beneﬁ cial eﬀ ects.
We declare that we have no conﬂ icts of interest.
usually reported for this patient group.3
*Ken-ichiro Inoue, Hirohisa Takano
We also feel we should point out We congratulate Nicole Ryan and firstname.lastname@example.org
that capsaicin cough responses colleagues1 on their article illustrating
Center for Medical Science, International University
reﬂ ect the cough reﬂ ex pathway in its the eﬃ
cacy of gabapentin in of Health and Welfare, Ohtawara, Tochigi 324-8501,
entirety and therefore cannot be used refractory chronic cough. We have Japan (KI); and Graduate School of Engineering, to diﬀ erentiate between sensitisation some questions and comments.
Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomised,
Moreover, the C5 endpoint shows to rule out whether any participants
double-blind, placebo-controlled trial. Lancet
such wide interperson variability that had cough-variant asthma? More
it cannot even clearly discriminate than 70% of patients in both the 2
Anon. Mycoplasmal pneumonia as of
September 2012, Japan. IASR
health from disease.4 This variability gabapentin and placebo groups had 3 Pugh MJ, Copeland LA, Zeber JE, et al.
probably explains the absence of previously been prescribed inhalers.
Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans.
diﬀ erence between gabapentin and Ryan and colleagues state that “All
J Am Geriatr Soc
participants had negative responses 4 Gibbons RD, Hur K, Brown CH, Mann JJ.
Finally, although gabapentin to previous investigations or trials of
Gabapentin and suicide attempts. Pharmacoepidemiol Drug Saf
improved cough-speciﬁ c quality of treatments for asthma”. However, it life in this study, an important out-
standing question for patients and such treatments successfully at ﬁ rst,
clinicians is whether this beneﬁ t suggesting that some cases of asthma be congratulated for increasing the outweighs the side-eﬀ ects and risks. could have been missed. Additionally, evidence base for the treatment In 2009, the US Food and Drug Ryan and colleagues did not mention of refractory chronic cough, which Administration issued a warning5
patients’ atopic pre disposition—eg, IgE
about depression and suicidal titre. This information would be useful.
Second, we wonder about the little comment on the eﬀ ect on quality
Submissions should be
taking anticonvulsants for any presence of mycoplasma-related of life as measured by the short form
made via our electronic
indication. The long-term tolerability respiratory symptoms in these 36 (SF36) questionnaire. Although submission system at
and safety in refractory cough patients. Japan is experiencing a they provide persuasive evidence that http://ees.elsevier.com/
therefore remains to be established.
progressing epidemic of mycoplasma gabapentin reduced cough frequency thelancet/
www.thelancet.com Vol 381 February 23, 2013
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