Article type
Year
Abstract
Background: A 54-year-old woman with chronic cough for 10 years secondary to interstitial pneumonia was non-responsive to several treatments. An improvement was observed with the use of tramadol 50 mg twice a day prescribed for pain control. In order to corroborate this observation, a double-blind randomized N-of-1 trial with controlled placebo was performed.
Objectives: To evaluate the efficacy of tramadol in patients with chronic cough.
Methodology: The N-of-1 study was performed in 3 pairs; each of them composed of one period of use of tramadol and one of placebo. At the end each period, the seriousness of the diurnal and nightly cough was evaluated by means of a visual scale (HSU et al, 1994) that ranges from 0 (no cough) to 5 (worst cough). In addition, the patient's perception in relation to her welfare as"better" ,"unchanged" or"worse" was also evaluated (Guyatt et al, 1998). The results were analyzed by calculating the probability of randomly obtaining a similar result, or better than the one found.
Results: A significant reduction (p = 0.001) was observed in the intensity of the diurnal and nightly cough evaluated by the patient through the visual scale in the period in which the medication was used in relation to placebo. The diurnal cough intensity reduced from 5 to 2 (placebo/tramadol) and the nightly cough intensity from 4 to 1 (placebo/tramadol). In relation to the welfare perception, in all periods that made use of tramadol the patient reported feeling 'better' than when she used placebo. In the third pair, the use of emergency tramadol was allowed (not blind) due to cough intensity. The patient was told to write down on a control sheet the day and the amount of emergency capsules taken with the objective of comparing both periods of the respective pair. One capsule/day of emergency tramadol was used in the 5 days in which placebo was used, while in the period for the use of the medication, the need for use of the emergency tramadol was not verified.
Conclusion: Tramadol was effective in controlling the patient's cough. Considering that this was the first study aimed at evaluating the antitussive activity of tramadol, further clinical assays must be conducted in order to corroborate its efficiency as an antitussive agent.
Objectives: To evaluate the efficacy of tramadol in patients with chronic cough.
Methodology: The N-of-1 study was performed in 3 pairs; each of them composed of one period of use of tramadol and one of placebo. At the end each period, the seriousness of the diurnal and nightly cough was evaluated by means of a visual scale (HSU et al, 1994) that ranges from 0 (no cough) to 5 (worst cough). In addition, the patient's perception in relation to her welfare as"better" ,"unchanged" or"worse" was also evaluated (Guyatt et al, 1998). The results were analyzed by calculating the probability of randomly obtaining a similar result, or better than the one found.
Results: A significant reduction (p = 0.001) was observed in the intensity of the diurnal and nightly cough evaluated by the patient through the visual scale in the period in which the medication was used in relation to placebo. The diurnal cough intensity reduced from 5 to 2 (placebo/tramadol) and the nightly cough intensity from 4 to 1 (placebo/tramadol). In relation to the welfare perception, in all periods that made use of tramadol the patient reported feeling 'better' than when she used placebo. In the third pair, the use of emergency tramadol was allowed (not blind) due to cough intensity. The patient was told to write down on a control sheet the day and the amount of emergency capsules taken with the objective of comparing both periods of the respective pair. One capsule/day of emergency tramadol was used in the 5 days in which placebo was used, while in the period for the use of the medication, the need for use of the emergency tramadol was not verified.
Conclusion: Tramadol was effective in controlling the patient's cough. Considering that this was the first study aimed at evaluating the antitussive activity of tramadol, further clinical assays must be conducted in order to corroborate its efficiency as an antitussive agent.