Association between chronic idiopathic cough and sensitive skin syndromes is a new argument in favor of common neuropathic pathways: results from a survey on 4050 subjects

Sensitive skin syndrome has a neuropathic origin, which is why it is frequently associated with irritable bowel syndrome. We have looked for a possible association with chronic cough, which is commonly maintained by neurogenic mechanisms, whatever the initial cause(s). A survey was carried out on a representative sample of the population over 15 years of age using the quota method. The questionnaire included sociodemographic data and questions about sensitive skin, the presence of chronic cough, smoking and possible causes of chronic cough. Chronic cough was assessed by the Leicester Cough Questionnaire, and 4050 subjects responded (mean age: 45 years). Overall, 12.2% of subjects with a chronic cough were compared to the 87.8% without any cough. Among them, 72.5% had sensitive skin (vs. 47.8%, p < 0.001); additionally, 17.4% of the subjects with sensitive skin had a chronic cough (vs. 6.9% if no sensitive skin). These proportions were higher if very sensitive skin was reported. The risk of having chronic cough was twice as high if sensitive skin was reported [OR = 1.9 (1.5–2.4), p < 0.001]. The risk of having sensitive skin was also twice as high for chronic cough. Thus, chronic cough and sensitive skin are frequently associated. This association represents a new argument in favor of a neuropathic nature of sensitive skin. Sensitive skin and chronic cough are both modes of overreaction to environmental factors, which tend to be autonomized by neurogenic mechanisms. Dermatologists should ask their patients if they have a chronic cough, and pneumologists should ask about the presence of sensitive skin.

The management of chronic cough

Summary Chronic cough is a common presentation to primary care and constitutes a significant volume of referrals to secondary care. It affects around 10% of the adult population and has a plethora of respiratory and non-respiratory causes. It can have a significant impact on the quality of life of affected individuals. In many patients, minimal baseline investigations lead to an easily identifiable and treatable cause. In others, no cause can be identified even after extensive investigations in specialized cough clinics. This evidence-based review article outlines the approach to the adult patient presenting with chronic cough and focuses upon current management strategies in those with chronic idiopathic cough. It includes results from trials of speech and language therapies, and the emerging concept of chronic idiopathic cough as a neuropathic disorder with its own bespoke approach to management including the use of neuromodulatory agents.

Utilization of gabapentin for cough in cancer: A case series.

241 Background: Refractory cough is a significant problem for cancer patients. Therapeutic options are suboptimal and based on low quality of evidence. Gabapentin is a gamma aminobutyric acid analog that may regulate neurotransmitter release via activity at the alpha-2-delta subunit of voltage dependent calcium channels. It is hypothesized to ameliorate cough through a central mechanism and is effective in relieving chronic refractory idiopathic cough. However, gabapentin has not been studied in cancer patients with cough. We report the use of gabapentin for chronic, refractory cough in adult cancer patients. Methods: We identified 3 male patients with metastatic cancer evaluated by palliative care for refractory cough. Data regarding diagnosis previous treatments for cough, dosage of gabapentin, and symptomatic outcomes are reported. Results: Case 1 is a 68 y.o. male with NSCLC and malignant pleural effusion had chronic cough despite thoracentesis that was associated with fatigue, sleep disturbance, and worsened with movement, pain, and sitting upright. Previous treatment for cough included benzonatate, codeine, dextromethorphan, albuterol inhaler, and ranitidine, without relief. He received gabapentin 300 mg three times a day. Case 2 was a 68 y.o. with NSCLC and a left mainstem bronchus obstructive mass not amenable to stent. Cough was associated with eating and sleep disturbance, and he could not lie flat for radiation planning. He received gabapentin 300 mg at night. Case 3 was a 48 y.o. with salivary duct carcinoma and a cavitary S. Pyogenes pneumonia treated with antibiotics and chest tube drainage and had persistent cough. He received gabapentin 300 at night. All patients had cough relief within 24 hours and were controlled until death. Conclusions: Gabapentin at doses up to 1800 mg per day has been studied in refractory chronic idiopathic cough and found effective relative to placebo with significantly more improvement in cough frequency, severity, and quality of life. Chronic cough in cancer patients can be a debilitating symptom and interventions are inadequately effective, with little quality evidence to support their use. Our case series suggests that further studies of gabapentin in cancer-related chronic cough are warranted.