Roxana Siles, MD, FAAAAI, staff in the Department of Allergy and Immunology at Cleveland Clinic and codirector of the Asthma Center at Cleveland Clinic, addresses the challenges of treating chronic cough.
Symptoms of chronic cough vary among patients, and controlling them can be challenging, so the aim is to maximize for each patient how their symptoms affect them. Shared decision-making is very important to limit treatment risks and maximize the benefits to patients, noted Roxana Siles, MD, FAAAAI, staff in the Department of Allergy and Immunology at Cleveland Clinic and codirector of the Asthma Center at Cleveland Clinic.
What do current clinical guidelines recommend for treatment of chronic cough?
As far as treatment guidelines, right now there’re no clear guidelines in terms of, “This is the medication of choice.” Once the common conditions are met and maximized in therapy, we’re left with things like cough suppressants. Those tend to have a lot of side effects that we have to worry about, including sedation. Some have more of an addictive potential. We do have neuromodulators that have been used for those patients who’ve been diagnosed with refractory cough. Again, those tend to have a lot of side effects also.
So again, different patients have different causes for their symptoms, and I think the key is to try to maximize how much of each condition is affecting this particular patient. But despite that, no matter what we do, it can be a challenge to keep symptoms controlled, which, unfortunately, affects patients’ quality of life and impacts their sleep in some cases, too.
Besides sedation and reduced quality of life, what are other adverse effects of chronic cough treatment?
I think those are the most common. When we think of cough suppressants, definitely those can certainly make patients very tired and even dizzy. But there’s always side effects with any medication we prescribe. For example, inhalers can sometimes lead to hoarseness or throat irritation that we have to be careful with. We always have to worry about long-term effects of using proton pump inhibitors or other antireflux therapies. So, this is where we have to really have shared decision-making and maximize the benefits by limiting the risks associated with potential adverse reactions to treatment.