Design: Single-centre, double-blind, placebo-controlled RCT
Population: 68 patients with IPF and chronic cough, China
Primary outcome: ≥50% reduction in cough symptom score at 12 weeks
Effect: 73.5% vs 26.5%; difference 47.1 points (95% CI 26.1 to 68.0)

This single-centre, double-blind trial in Shanghai randomised 68 patients with IPF and chronic cough (visual analogue score 40 mm or more) to gabapentin titrated to 900 mg a day or placebo for 12 weeks. It was published in Chest in August.

At the end of treatment, 73.5% on gabapentin achieved at least a 50% reduction in cough symptom score versus 26.5% on placebo (difference 47.1 percentage points, 95% CI 26.1 to 68.0). Adverse events were more common with gabapentin (32.4% vs 8.8%), mainly drowsiness, fatigue and dizziness.

Cough is one of the most distressing symptoms of IPF, and antifibrotics do little for it. Gabapentin is cheap and widely available, including in India. The trial is small, and sedation in breathless, often older patients needs watching.

Consider gabapentin for troublesome IPF cough after excluding reflux and other causes.
Start low and titrate to 900 mg a day.
Adjust the dose for renal function.
Warn about drowsiness and falls; avoid combining with opioids where possible.

Why it matters

It offers a cheap, available option for a symptom antifibrotics do not address.

The statistics, in plain English

The difference is large, but the interval (26 to 68 percentage points) is wide because only 68 patients took part. Sedating side effects can partly unblind a trial, which may inflate symptom-based outcomes.