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We hypothesised that noxious airway sensations (\n                      <jats:italic>e.g.<\/jats:italic>\n                      throat irritation, tickle, urge to cough) described by RCC patients play a role in initiating coughing and are lessened by morphine.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>22 RCC patients (median age 65\u2005years; 83% female) reporting a clinical response to low-dose morphine withdrew from therapy and enrolled in a double-blinded, randomised, placebo-controlled, crossover trial comparing the effects of their usual dose of morphine with those of a matched placebo. The sensations evoked by citric acid inhalation were assessed at baseline and at the end of each 5\u20137-day treatment period. The efficacy of morphine, compared with placebo, was assessed by objective cough monitoring and patient-reported outcomes at the same time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Compared with placebo, low-dose morphine improved the rating of all sensations provoked by citric acid inhalation (all p&lt;0.05), but the cough threshold (C2) was not changed (p=0.61). 24-hour cough frequency was reduced by 71.8% with low-dose morphine, compared with placebo treatment (p&lt;0.001), and all patient-reported outcomes significantly improved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>This trial suggests that the antitussive action of low-dose morphine may be a consequence of modulation of noxious airway sensations and provides the first objective evidence of its efficacy in RCC patients reporting a clinical response.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.00173-2026","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:39:00Z","timestamp":1778769540000},"page":"00173-2026","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Low-dose morphine and airway sensations in refractory chronic cough: a randomised control trial"],"prefix":"10.1183","volume":"12","author":[{"given":"Bashar 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