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Management of chronic cough
1Institute for Lung Health, Department of Respiratory Medicine, Allergy and Thoracic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
Lancet (London, England)
|April 22, 2008
Summary
Chronic cough often requires secondary care. New approaches distinguish between eosinophilic and non-eosinophilic cough, emphasizing the heightened cough reflex for better treatment development.
Area of Science:
- Pulmonology
- Clinical Medicine
- Pathophysiology
Background:
- Unexplained chronic cough is a frequent referral reason to secondary care.
- Current management often relies on case series, attributing cough to asthma, reflux, or upper airway conditions.
- A significant portion of patients in secondary care do not achieve satisfactory cough control.
Purpose of the Study:
- To advocate for a paradigm shift in chronic cough management.
- To differentiate between corticosteroid-responsive eosinophilic airway diseases and corticosteroid-resistant non-eosinophilic cough.
- To encourage research into the pathophysiology of heightened cough reflex and novel antitussive treatments.
Main Methods:
- Review of existing evidence on chronic cough management.
- Proposed reclassification of cough based on airway inflammation and reflex sensitivity.
- Recommendation for evaluating aggravating factors versus intrinsic reflex abnormalities.
Main Results:
- Traditional treatments for asthma, reflux, and upper airway conditions are not universally effective for chronic cough.
- A substantial number of patients present with chronic cough refractory to standard care.
- The belief that comorbid conditions solely cause cough may hinder research into reflex pathophysiology.
Conclusions:
- A clear distinction between eosinophilic and non-eosinophilic cough is necessary.
- Factors with weak evidence should be considered aggravating, not causative, of cough reflex abnormality.
- Further research into the mechanisms and pharmacological control of heightened cough reflex is crucial for developing improved treatments.
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