Therapeutic Potential of Intranasal Corticosteroids for Chronic Cough

Background: Chronic cough, a condition defined as a cough persisting for more than 8 weeks, remains a significant clinical challenge with a considerable impact on quality of life. Intranasal corticosteroids (INCS) are widely recommended in clinical guidelines for managing chronic cough, particularly in patients with associated upper airway conditions. However, the evidence base directly supporting this practice is surprisingly sparse, leaving clinicians to navigate a disconnect between guidelines and real-world applicability. Objective: This article offers a critical perspective on the role of INCS in chronic cough management, drawing attention to the paucity of direct evidence and proposing a roadmap for future research. Discussion: A recent systematic review aiming to evaluate the efficacy and safety of INCS for chronic cough yielded no eligible studies, despite extensive database searches. This unexpected outcome highlights a major gap in the literature and raises important questions about the foundation of current guideline recommendations. While INCS are biologically plausible and have demonstrated efficacy in related conditions, such as allergic rhinitis and chronic rhinosinusitis, their specific role in chronic cough remains unverified. The lack of robust clinical trials underscores the need for targeted research to determine whether INCS provide meaningful benefit in this population. Conclusion: The disconnect between recommendations and evidence in chronic cough management underscores a critical need for well-designed randomized controlled trials. Until such data are available, clinicians must balance existing guidelines with clinical judgment, individualizing treatment to address the unique needs of their patients. Bridging this evidence gap will not only enhance patient care but also refine guideline development, ensuring recommendations are firmly grounded in high-quality research.