The edition · Pulmonology
Gabapentin gets a trial in fibrotic cough, and it works
A placebo-controlled trial in idiopathic pulmonary fibrosis finds three-quarters of patients get meaningful cough relief. Also: an expert consensus on when to screen rheumatoid arthritis for lung disease, who actually progresses to severe asthma after a first exacerbation, and what wood dust does to the lungs of workers who breathe it.
The edition in brief
A randomised, double-blind, placebo-controlled trial at a single Chinese centre gave 68 patients with idiopathic pulmonary fibrosis and cough lasting over eight weeks either gabapentin titrated to a maximum 900 mg/day or placebo for 12 weeks. Cough relief — at least a 50% fall in Cough Symptom Score — was reached by 73.5% on gabapentin against 26.5% on placebo, a placebo-adjusted difference of 47.1 percentage points (95% CI 26.1 to 68.0, P < 0.001). Adverse events affected 32.4% versus 8.8%, chiefly drowsiness, fatigue and dizziness. An international expert group issued consensus statements on rheumatoid arthritis-associated interstitial lung disease, covering risk factors, screening and treatment. The group convened explicitly because high-quality studies are too scarce to support strict evidence-based guidelines, and synthesised the evidence qualitatively instead. A Danish cohort within the NORDSTAR collaboration followed 99,748 adults with mild-to-moderate asthma from their first exacerbation for five years. Overall, 4.1% progressed to severe asthma. Risk factors were exacerbation despite medium-dose inhaled corticosteroid (OR 3.72, 95% CI 3.39-4.09), blood eosinophils at or above 0.6 x 10^9/L (OR 1.97, 1.47-2.61), high short-acting beta agonist use (OR 1.76, 1.64-1.90), two or more respiratory infections (OR 1.61, 1.49-1.73) and age 40-49 (OR 1.62, 1.49-1.77). A patient with all of these had a 30.4% five-year risk. A meta-analysis of 55 studies of occupational wood dust exposure found pooled reductions of 8.57 percentage points in FEV1 % predicted (95% CI -12.07 to -5.08), 7.43 in FVC and 13.43 in PEFR, with heterogeneity above 95% and signs of publication bias.
Rheumatoid arthritis-associated lung disease: consensus where the evidence will not support a guideline
An expert group has issued consensus statements on screening for, diagnosing and treating rheumatoid arthritis-associated interstitial lung disease — useful for building a joint pathway with rheumatology, but consensus rather than trial evidence, and it says so.
After a first asthma exacerbation, most patients do not progress — and you can tell which ones might
Only 4.1% of adults progress to severe asthma in the five years after a first exacerbation, but exacerbating despite medium-dose inhaled corticosteroid, eosinophils at or above 0.6, high reliever use and recurrent infections together put that risk near 30%.
Wood dust and the working lung: a large signal in a noisy literature
Workers exposed to wood dust had FEV1 about 8.6 percentage points and PEFR about 13.4 points lower than unexposed workers — enough to make an occupational history and spirometry, rather than an empirical inhaler, the right first step.
Chronic cough: the three drugs and the one question people forget
In chronic cough, stop the ACE inhibitor for a full four weeks whatever the duration of use, exclude reflux and post-nasal drip, and always ask what the patient does at work and what they burn at home.
Gabapentin for the cough of idiopathic pulmonary fibrosis
Gabapentin at up to 900 mg daily gave at least 50% cough relief to 73.5% of patients with idiopathic pulmonary fibrosis against 26.5% on placebo — a cheap, available option for a symptom that has had none.
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