Usefulness of suplatast tosilate for chronic cough following lung cancer surgery

Pulmonary vagus nerve transection for chronic cough after video-assisted lobectomy: a randomized controlled trial

BACKGROUND

Chronic cough is common after lobectomy. Vagus nerves are part of the cough reflex. Accordingly, transection of the pulmonary branches of vagus nerve may prevent chronic cough. And there are no clear recommendations on the management of the pulmonary branches of vagus in any thoracic surgery guidelines.

METHODS

This is a single-center, randomized controlled trial. Adult patients undergoing elective video-assisted thoracoscopic lobectomy and lymphadenectomy were randomized at a 1:1 ratio to undergo a sham procedure (control group) or transection of the pulmonary branches of the vagus nerve that innervate the bronchial stump plus the caudal-most large pulmonary branch of the vagus nerve. The primary outcome was the rate of chronic cough, as assessed at 3 months after surgery in the intent-to-treat population.

RESULTS

Between 1 February 2020 and 1 August 2020, 116 patients (59.6±10.1 years of age; 45 men) were randomized (58 in each group). All patients received designated intervention. The rate of chronic cough at 3 months was 19.0% (11/58) in the vagotomy group versus 41.4% (24/58) in the control group (OR=0.332, 95% CI: 0.143-0.767; P =0.009). In the 108 patients with 2-year assessment, the rate of persistent cough was 12.7% (7/55) in the control and 1.9% (1/53) in the vagotomy group ( P =0.032). The two groups did not differ in postoperative complications and key measures of pulmonary function, for example, maximal voluntary ventilation, diffusing capacity of the lungs for carbon monoxide, and forced expiratory volume.

CONCLUSION

Transecting the pulmonary branches of vagus nerve that innervate the bronchial stump plus the caudal-most large pulmonary branch decreased the rate of chronic cough without affecting pulmonary function in patients undergoing video-assisted lobectomy and lymphadenectomy.

Pulmonary Rehabilitation Exercises Effectively Improve Chronic Cough After Surgery for Non-small Cell Lung Cancer

INTRODUCTION

Cough is a major complication after lung cancer surgery, potentially impacting lung function and quality of life. However, effective treatments for managing long-term persistent postoperative cough remain elusive. In this study, we investigated the potential of a pulmonary rehabilitation training program to effectively address this issue.

METHODS

Between January 2019 and December 2022, a retrospective review was conducted on patients with non-small cell lung cancer (NSCLC) who underwent lobectomy and lymph node dissection via video-assisted thoracoscopic surgery (VATS) at Daping hospital. Based on their postoperative rehabilitation methods, the patients were categorized into 2 groups: the traditional rehabilitation group and the pulmonary rehabilitation group. All patients underwent assessment using the Leicester cough questionnaire (LCQ) on the third postoperative day. Additionally, at the 6-month follow-up, patients' LCQ scores and lung function were re-evaluated to assess the long-term effects of the pulmonary rehabilitation training programs.

RESULTS

Among the 276 patients meeting the inclusion criteria, 195 (70.7%) were in the traditional rehabilitation group, while 81 (29.3%) participated in the pulmonary rehabilitation group. The pulmonary rehabilitation group showed a significantly lower incidence of cough on the third postoperative day (16.0% vs 29.7%, P = .018) and higher LCQ scores in the somatic dimension (5.09 ± .81 vs 4.15 ± 1.22, P = .007) as well as in the total score (16.44 ± 2.86 vs 15.11 ± 2.51, P = .018, whereas there were no significant differences in psychiatric and sociological dimensions. At the 6-month follow-up, the pulmonary rehabilitation group continued to have a lower cough incidence (3.7% vs 12.8%, P = .022) and higher LCQ scores across all dimensions: somatic (6.19 ± .11 vs 5.75 ± 1.20, P = .035), mental (6.37 ± 1.19 vs 5.85 ± 1.22, P = .002), sociological (6.76 ± 1.22 vs 5.62 ± 1.08, P < .001), and total (18.22 ± 2.37 vs 16.21 ± 2.53, P < .001). Additionally, lung function parameters including FVC, FVC%, FEV1, FEV1%, MVV, MVV%, DLCO SB, and DLCO% were all significantly higher in the pulmonary rehabilitation group compared to the traditional group.

CONCLUSION

Pulmonary rehabilitation exercises significantly reduced the incidence of postoperative cough and improved cough-related quality of life in patients undergoing lobectomy, with sustained benefits observed at the 6-month follow-up. Additionally, these exercises demonstrated superior lung function outcomes compared to traditional rehabilitation methods.

Factors and potential treatments of cough after pulmonary resection: A systematic review

Cough is a common complication following pulmonary resection. Persistent and severe cough after pulmonary resection can cause significant impairments in quality of life among postoperative patients. Complications of cough can be life-threatening. To improve patients' probability and quality of life, factors that induce cough after pulmonary resection (CAP) and potential treatments should be explored and summarized. Previous studies have identified various factors related to CAP. However, those factors have not been categorized and analyzed in a sensible manner. Here, we summarized the different factors and classified them into four groups. Potential therapies might be developed to selectively target different factors that affect CAP. However, the exact mechanism underlying CAP remains unknown, making it difficult to treat and manage CAP. In this review, we summarized the latest studies in our understanding of the factors related to CAP and potential treatments targeting those factors. This review can help understand the mechanism of CAP and develop efficient therapies and management.

Increased expression of TRPV1 in patients with acute or chronic cough after lung cancer surgery

BACKGROUND

We investigated preoperative and postoperative TRPV1, bradykinin (BK), and prostaglandin e-2 (PGE2) levels in patients who underwent lung cancer surgery and evaluated the correlations between these levels and the development of acute or chronic cough after surgery.

METHODS

We evaluated 60 patients with non-small cell lung cancer who underwent lobectomy at our center between August and October 2018. TRPV1, BK, and PGE2 levels were determined by enzyme-linked immunosorbent assay and postoperative cough was assessed using the visual analog scale (VAS).

RESULTS

The postoperative serum TRPV1, BK, and PEG2 levels of the 60 patients were significantly higher than the preoperative levels (P < 0.001). Thirty-five patients (58.3%) were diagnosed with acute cough (VAS ≥ 60 mm), and 25 were diagnosed with non-acute cough (41.7%). Three days after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the acute cough group than in the non-acute cough group (P < 0.001). Twenty-two patients (36.7%) were diagnosed with chronic cough (VAS ≥ 60 mm), and 25 (62.3%) were diagnosed with non-chronic cough. Eight weeks after surgery, the serum TRPV1, BK, and PGE2 levels were significantly higher in the chronic cough group than in the non-chronic cough group (P < 0.05).

CONCLUSIONS

The postoperative TRPV1, BK and PGE2 levels were significantly higher than the preoperative levels. The TRPV1 level was also higher in patients with an acute or chronic cough than in patients without. Postoperative acute or chronic cough symptoms can be improved and alleviated by blocking the TRPV1 pathway.

[A study on quality of life after thoracoscopic assistant lobectomy for lung cancer]

BACKGROUND

Conventional radical surgeries for lung cancer incur a large amount of trauma, thoracoscopic surgeries can reduce trauma, and hopefully improve patients' postoperative quality of life (QOL). The aim of this study is to evaluate the impact of thoracoscopic radical surgeries on quality of life of patients with non-small cell lung cancer (NSCLC).

METHODS

Use Quality of Life-Core 30 Questionnaire (QLQ-C30) which was exploited by European Organization for Research and Treatment (EORTC) and Quality of Life-Lung Cancer 13 Questionnaire (QLQ-LC13) which is the supplementary questionnaire according to the lung cancer patients to evaluate QOL of 60 NSCLC patients in thoracoscopic surgery group and conventional surgery group from 3 days before operation to 24 weeks after operation.

RESULTS

A total of 215 questionnaires were collected from 60 patients; 25 postoperative questionnaires were not completed because patients could not be contacted for follow-up visits. QOL declined markedly in all patients at 3 days postoperatively; preoperative and 3-day postoperative global QOL scores in the conventional surgery and thoracoscopic surgery group were 87.8 ± 10.3 vs 38.3 ± 13.1 (P<0.001) and 82.7 ± 9.6 vs 56.3 ± 14.8 (P<0.001), respectively. Thereafter, QOL recovered gradually in all patients. Patients who underwent open surgery showed the most pronounced decline in QOL; global scores were lower in this group than in the thoracoscopic surgery group (P=0.012,9) at 3 days postoperatively and was not restored to the preoperative level at 24 weeks postoperatively (P=0.012,4). QOL declined less in patients undergoing thoracoscopic surgery, and most indices had recovered to preoperative levels at 24 weeks postoperatively.

CONCLUSIONS

With the advantages of small trauma, faster recovery and higher postoperative QOL, thoracoscopic surgery is a preferable lung cancer surgery.

Inhalation of corticosteroid and β-agonist for persistent cough following pulmonary resection

BACKGROUND

Patients undergoing pulmonary resection often suffer from a dry, hacking cough, which is usually refractory to opioid cough suppressors such as codeine. The cough is often painful and impairs the quality of life of the patients. The efficacy of an inhaled corticosteroid plus β2-agonist against the persistent cough after pulmonary resection was evaluated in this study.

METHODS

We enrolled 21 patients in this prospective study of the efficacy of an inhaled corticosteroid plus β2-agonist against persistent cough following pulmonary resection. After baseline evaluation of the severity of the postoperative persistent cough using a visual analog scale (VAS), treatment with an inhaled corticosteroid plus β2-agonist was initiated and continued for 2 weeks. At the end of the 2 weeks, the cough severity was evaluated again using a VAS.

RESULTS

The median grade of cough on the VAS before the start of the inhaled treatment was 4 (range 3-8). At the end of 2 weeks of treatment with an inhaled corticosteroid plus β2 agonist, the median grade of cough on the VAS decreased from 4 to 1 (range 0-4). As an adverse effect of the inhalation, hoarseness was observed in one patient, which disappeared promptly after discontinuing the inhalations.

CONCLUSION

Treatment with an inhaled corticosteroid plus β2 agonist appeared to be highly effective, without severe adverse effects, against the persistent cough suffered by patients after pulmonary resection.