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Non-asthmatic eosinophilic bronchitis — SCE Respiratory MCQ

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HardCoughNon-asthmatic eosinophilic bronchitisSCE Respiratory

A 59-year-old woman has refractory dry cough after systematic treatment of eosinophilic airway disease, rhinosinusitis and proven reflux. Cough-control therapy helped only partially, and gabapentin caused disabling dizziness. Which specialist pharmacological trial is supported by BTS?

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Correct answer: E — Slow-release morphine 5 mg twice daily with early response and toxicity review

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

B is correct. For refractory cough driven by cough hypersensitivity, BTS supports a monitored trial of low-dose slow-release morphine, commonly 5 mg twice daily and sometimes increased to 10 mg twice daily. Benefit usually appears quickly, so non-responders should stop and responders require constipation and sedation review. Codeine has unreliable antitussive efficacy; evidence for dextromethorphan and amitriptyline is insufficient for this recommended specialist regimen, and macrolides are reserved for selected productive inflammatory cough phenotypes rather than refractory dry cough.

Reference: BTS Clinical Statement on chronic cough in adults: https://thorax.bmj.com/content/78/Suppl_6/s3