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Association Between Gabapentinoid Prescription and Chronic Obstructive Pulmonary Disease Exacerbation in Patients With Chronic Cough
Abstract   Peer reviewed

Association Between Gabapentinoid Prescription and Chronic Obstructive Pulmonary Disease Exacerbation in Patients With Chronic Cough

P Lim, A Mahmoud and P Tiberio
American journal of respiratory and critical care medicine, v 212(Supplement_1), A44-20
01 May 2026
DOI: https://doi.org/10.1093/ajrccm/aamag162.1669

Abstract

Chronic obstructive pulmonary disease Intubation Mortality Respiratory failure Ventilators
Rationale Chronic obstructive pulmonary disease (COPD) is a global health problem affecting over 200 million adults globally. Patients with COPD are susceptible to medication-related exacerbations, and exacerbations increase risk of hospitalization and lead to increased morbidity and mortality. Gabapentin is often prescribed off-label for chronic cough. Gabapentinoid use for epilepsy, neuropathic pain, or chronic pain has been associated with increased risk of COPD exacerbations. Since patients with COPD often present with chronic cough, we investigated the association of gabapentin and COPD exacerbation in patients with COPD and chronic cough. Methods In this retrospective study using TriNetX platform, we identified patients (≥18 years old) using ICD-10 codes for COPD (J44.0-J44.1) and chronic cough (R05 or R05.3) from January 2012 to January 2024. We created two cohorts based on gabapentin prescriptions. We conducted propensity score matching using demographic, comorbidities, and medications covariates. At 6-months and 12-months follow up periods, we assessed COPD exacerbations, inpatient and ICU admissions, mortality, acute respiratory failure, invasive mechanical ventilation, emergent intubation, prednisone exposure, and acute cardiovascular events. Results A total of 623,308 patients were identified for the control cohort and 15,681 patients in the gabapentinoid cohort. After matching, 15,681 patients were included in each cohort (44.4% men; mean age at index 65 years; 77% non-Hispanic). At 6 months, patients prescribed with gabapentinoids had a higher rate of COPD exacerbations (RR: 1.205, 95% CI 1.158 - 1.255), inpatient admission (RR: 1.938, 95% CI 1.875 - 2.004), ICU services (RR: 1.730, 95% CI 1.611 - 1.859), mortality (HR: 1.223, 95% CI 1.134 - 1.319), acute respiratory failure (RR: 1.498, 95% CI 1.409 - 1.593), invasive mechanical ventilation (RR: 1.761, 95% CI 1.551 - 1.999), emergent intubation (RR: 1.830, 95% CI 1.550 -2.161), prednisone exposure (RR: 1.463, 95% CI 1.415 - 1.513), and acute cardiovascular events (RR: 1.438, 95% CI 1.313 - 1.576). Similar outcomes were seen at 12-months. Conclusion COPD patients prescribed gabapentinoids for chronic cough were associated with worse outcomes at both 6-month and 12-month follow up periods. This is the first study to our knowledge evaluating the effects of gabapentinoids for chronic cough in patients with COPD. These findings underscore the need for future prospective studies evaluating clinical outcomes for patients with COPD on high-risk medications. Careful consideration should be made when prescribing gabapentinoids in this patient population, as it may lead to increased CNS depression and worse outcomes.

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