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Chronic cough as a neuropathic disorder
Kian Fan Chung1, Lorcan McGarvey2, Stuart B Mazzone3
1Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton Hospital, London, UK.
The Lancet. Respiratory Medicine
|January 17, 2014
Summary
Chronic cough may stem from neuropathic pain, suggesting a new treatment approach. This perspective explores chronic cough as a disorder of neural pathways, potentially improving antitussive therapies.
Area of Science:
- Neurology
- Pulmonology
- Pharmacology
Background:
- Chronic cough presents significant clinical challenges due to inadequate relief from standard treatments and elusive causes.
- Patients often report sensory symptoms indicating upper airway and laryngeal neural dysfunction.
- Cough triggered by low-level stimuli suggests hyperresponsiveness of the cough reflex.
Purpose of the Study:
- To propose that chronic cough is a neuropathic disorder.
- To review evidence supporting the neuropathic basis of chronic cough.
- To explore the implications for developing novel antitussive treatments.
Main Methods:
- Review of existing literature on chronic cough pathophysiology.
- Analysis of sensory symptoms and cough reflex characteristics.
- Examination of treatment outcomes using neuropathic pain agents.
Main Results:
- Evidence suggests neural damage to vagal sensory nerves contributes to chronic cough.
- Inflammatory, infective, and allergic factors are implicated in neural damage.
- Agents used for neuropathic pain, like gabapentin and amitriptyline, show potential efficacy.
Conclusions:
- Chronic cough can be conceptualized as a neuropathic disorder.
- Viewing chronic cough as neuropathic may guide the development of more effective antitussives.
- Targeting neural pathways offers a promising avenue for managing chronic cough.
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