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Chronic cough: is the end nigh?
Barnaby Hirons1,2, Richard Turner3,4, Peter S P Cho1,2
1Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK.
Breathe (Sheffield, England)
|February 14, 2024
Summary
Refractory or unexplained chronic cough (RU-CC) may stem from cough hypersensitivity. Emerging treatments, including neuromodulators and novel drugs like gefapixant, offer hope, though research gaps remain.
Area of Science:
- Pulmonology
- Neurology
- Pharmacology
Background:
- Chronic cough, defined as lasting over 8 weeks, significantly impacts patients' psychosocial well-being.
- Refractory or unexplained chronic cough (RU-CC) remains a challenge despite established guidelines.
- Growing evidence implicates cough hypersensitivity, supported by neuropathophysiological findings, in RU-CC.
Purpose of the Study:
- To review the current understanding of chronic cough, focusing on cough hypersensitivity.
- To discuss advancements in diagnostic and therapeutic approaches for RU-CC.
- To highlight future directions and challenges in the field of chronic cough management.
Main Methods:
- Review of recent scientific insights and clinical evidence regarding chronic cough.
- Discussion of neuropathophysiological evidence, including inhalational cough challenge testing, fMRI, and nerve biopsy.
- Analysis of current and emerging pharmacological (neuromodulators, P2X3 antagonists) and non-pharmacological treatments.
Main Results:
- Cough hypersensitivity is increasingly recognized as a key mechanism in RU-CC.
- Novel therapeutic strategies, including the P2X3 receptor antagonist gefapixant, are emerging.
- Repurposed neuromodulator medications show promise in managing chronic cough.
Conclusions:
- While challenges like the need for better data and clinical trials persist, the outlook for chronic cough treatment is improving.
- Further research into diagnostic tools, epidemiological data, and mechanistic studies is crucial.
- The development of targeted therapies and improved management strategies offers optimism for patients with chronic cough.
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