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35th AM (2025) - Poster Session
Partial Resolution of Severe Intractable Chronic C ...
Partial Resolution of Severe Intractable Chronic Cough with Low-Dose Sublingual Buprenorphine
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Pdf Summary
This case report details the partial resolution of severe, unexplained chronic cough (UCC) in a woman with a history of opioid use disorder (OUD) and seizure disorder, using low-dose sublingual buprenorphine. UCC, defined as a cough lasting over eight weeks without identifiable cause despite exhaustive evaluation, severely impaired the patient's quality of life, causing frequent coughing episodes that led to vomiting and disrupted work, travel, and daily activities. Conventional treatments—including benzonatate, corticosteroids, proton pump inhibitors, speech therapy, and ENT interventions—were ineffective. Due to her OUD history, tramadol was avoided.<br /><br />After multidisciplinary consultation, a supervised trial of buprenorphine was initiated. Buprenorphine’s pharmacological profile as a partial μ-opioid agonist with a ceiling effect on respiratory depression suggests it may be safer than other opioids, especially for patients prone to seizures or overdose. Within 10 days of starting buprenorphine, the patient experienced rapid, marked cough reduction and eventual complete resolution with buprenorphine/naloxone. Over several months, the dose was tapered, resulting in sustained symptom control. Although mild cough recurred with exertion, symptoms remained well controlled on maintenance dosing, with minimal daily impact and no further vomiting.<br /><br />This report highlights buprenorphine as a potentially valuable therapeutic option for refractory UCC, especially in patients with limited treatment alternatives and histories of substance use. The authors call for further research into buprenorphine’s mechanisms in cough suppression and its broader applicability. This case underscores the profound disability caused by UCC and the urgent need for novel therapies beyond current guideline-recommended treatments.
Keywords
unexplained chronic cough
UCC
buprenorphine
opioid use disorder
OUD
seizure disorder
sublingual buprenorphine
partial μ-opioid agonist
refractory cough treatment
buprenorphine/naloxone
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