Changing the paradigm for cough: does 'cough hypersensitivity' aid our understanding?

Area of Science:

• Pulmonology
• Neurology
• Immunology

Background:

• Chronic cough is a prevalent condition leading patients to seek medical attention.
• Current diagnostic approaches focus on identifying and treating specific causes of chronic cough.
• A significant number of chronic cough cases remain idiopathic despite thorough evaluation.

Purpose of the Study:

• To propose a new conceptual framework for understanding chronic cough.
• To re-evaluate the underlying mechanisms of chronic cough beyond traditional etiological factors.
• To introduce the concept of "cough hypersensitivity syndrome".

Main Methods:

• Review of existing literature on chronic cough pathophysiology.
• Analysis of commonly associated conditions (e.g., rhinitis, asthma, GERD) as potential triggers versus fundamental causes.
• Exploration of multifactorial influences including biologic, neurologic, immunologic, genetic, comorbid, and environmental factors.

Main Results:

• Traditional causes may act as triggers rather than fundamental drivers of chronic cough.
• Persistent upregulation of the cough reflex is identified as a cardinal feature.
• Complex interactions between various factors contribute to cough reflex hypersensitivity.

Conclusions:

• The "cough hypersensitivity syndrome" paradigm offers a novel perspective on chronic cough.
• This new framework may enhance the understanding of idiopathic chronic cough.
• The proposed syndrome could lead to advancements in the management of chronic cough.