Clinical Citations: Zeroing in on an effective treatment for idiopathic chronic cough

Although the cause of chronic cough can often be identified (with asthma and postnasal drip being 2 of the most common culprits), it sometimes eludes diagnosis. Bastian and associates studied a group of patients with idiopathic chronic cough that was diagnosed clinically as sensory neuropathic cough. They found that this type of cough responded well to the tricyclic antidepressant amitriptyline.

The study included 12 patients (between ages 20 and 75 years) who had a nonproductive cough of 2 months to 20 years in duration, a pronounced "tickle" in the throat or neck, episodes of severe coughing, and no benefit from a variety of treatments. Common triggers of the cough are shown in the Table.

The patients were treated with amitriptyline, 10 mg 2 hours before bedtime, for 21 days. Eleven of the 12 patients had prompt significant reduction of cough. Patients had an average maximal improvement of 75% (range, 10% to 100%); the maximal benefit of treatment was reported after a median of 5 days (range, 1 to 10 days). There was no correlation between the duration of cough and the response to amitriptyline.

The investigators concluded that a trial of amitriptyline may be helpful in the treatment of sensory neuropathic cough.