(0816) Identifying Patient Characteristics and Neuromodulator Treatment Patterns in Adults With Refractory or Unexplained Chronic Cough

Introduction: Neuromodulators, a therapeutic option for refractory or unexplained chronic cough (CC), lack established guidelines for optimal treatment durations. This study investigates the ideal neuromodulator duration for CC and the effect of concurrent behavioral treatment.

Methods: A retrospective chart review included subjects aged 18 or older, diagnosed with refractory or unexplained CC, evaluated at NYU Langone’s Voice Center, and trialed on neuromodulators for CC from June 2013 and June 2023. Descriptive statistics analyzed demographics and treatment patterns. The Wilcoxon-signed rank test compared cough severity index (CSI) scores before and after treatment, while Pearson correlation explored the relationship of neuromodulator improvement with or without behavioral therapy.

Results: Chart review involved 98 subjects meeting inclusion criteria, resulting in a final cohort of 47 after excluding those with less than a 4-week follow-up. Of these, 25 (53%) switched neuromodulators, totaling 72 trials of treatment. Clinical improvement occurred in 44 (81.8%) on tramadol, 16 (62.5%) on gabapentin, and 12 (83.3%) on amitriptyline, at median treatment durations of 10, 4.4, and 22 weeks, respectively. CSI scores for 11 patients showed a significant median change of –4 (p < 0.05). Among 9 patients who received behavioral therapy and neuromodulators, 5 (55%) reported improvement, with a median of three behavioral sessions. Of the 5 patients, 4 (80%) used tramadol for a median of 13.8 weeks.

Conclusions: This study suggests longer neuromodulator treatment for CC may be necessary. Behavioral therapy may enhance CC outcomes with neuromodulator treatment. Further investigation of this synergistic effect can inform recommendations for treatment plans.