Idiopathic pulmonary fibrosis and troublesome cough

What management would you recommend in a patient with idiopathic pulmonary fibrosis (IPF) and troublesome cough? A study published some time ago suggested thalidomide was effective in the treatment of cough in patients with IPF. Is thalidomide used for this indication outside clinical trials?

Luca Richeldi: Patients with severe cough in IPF are a major clinical problem because usually this cough is not treatable. So we use everything: we use inhaled drugs, we use codeine, we use morphine. There has been a trial of thalidomide in patients with chronic progressive fibrotic disorder and untreatable cough; it included IPF patients but also patients with other diseases. The trial is supportive.

There are two problems with thalidomide: one, it is an expensive drug; and secondly, safety may be a problem. But I would recommend – if available – to use that drug at least in some patients, being very careful of the benefits and risks ratio.