High dose Emblica officinalis on cough suppression during endobronchial ultrasound bronchoscopy compared to Dextromethorphan and Placebo: a double blinded randomized controlled trial.

<bold>Background:</bold> Coughing during bronchoscopy is related to patient’s discomfort and difficulty performing the procedure which may lead to complications. EBUS bronchoscopy is found to be one of significant factors related to cough. <italic>Emblica officinalis</italic> (EO) is a fruit widely used as traditional medicine, one of the effects is cough suppression and is found to be dose related. <bold>Objectives:</bold> To study the efficacy of high-dose EO as oral premedication before EBUS bronchoscopy in cough suppression effect compared to dextromethorphan and placebo. <bold>Methods:</bold> In this prospective, double blinded, randomized controlled trial, patients age 18 - 80 years old, scheduled for EBUS bronchoscopy were randomized into 3 groups to take the premedication drugs; EO 1500 mg, dextromethorphan 60 mg. and placebo groups. The cough sound will be recorded and compared between each group. <bold>Result:</bold> 80 patients completed the study. There were 27 patients in each EO and dextromethorphan groups and 26 patients in placebo groups. Baseline characteristics were similar. The median cough count (first-third quartile) was significantly lower in Eo 21 (9-42) and dextromethorphan 20 (12-39) than placebo group 50 (36-59) with P-value 0.001. Score of procedure interference by cough was lowest in EO group. There were no drug side effects or complications in EO group compared to placebo. <bold>Conclusion:</bold> High dose Emblica officinalis 1,500 mg was effective in reducing cough count during EBUS bronchoscopy and was non inferior compared to dextromethorphan with no drug side effects.