Reframing Refractory Chronic Cough: The Role of Interoception.

Area of Science:

• Neuroscience
• Pulmonology
• Behavioral Medicine

Background:

• Refractory chronic cough (RCC) presents a significant clinical challenge, often unresponsive to conventional therapies.
• Emerging research suggests RCC is a central hypersensitivity disorder, involving impaired interoception and inhibitory control.
• Similar neurophysiological mechanisms are observed in disorders like overactive bladder (OAB) and urinary urge incontinence (UUI).

Purpose of the Study:

• To explore the potential of behavioral interventions, drawing parallels with successful OAB/UUI treatments, for managing RCC.
• To investigate how behavioral cough suppression therapy (BCST) may leverage neuroplasticity to improve interoceptive processing and inhibitory control in RCC patients.
• To highlight the multi-dimensional nature of interoception and its relevance to developing comprehensive RCC therapies.

Main Methods:

• Review of neuroimaging findings in RCC patients revealing abnormalities in interoception and inhibitory control regions.
• Examination of the efficacy and neuroplastic effects of behavioral treatments for OAB/UUI.
• Analysis of behavioral cough suppression therapy (BCST) as a potential intervention for RCC, considering its impact on neural pathways.

Main Results:

• Neuroimaging studies indicate altered brain activity in regions governing interoception and inhibition in RCC patients.
• Behavioral treatments for OAB/UUI demonstrate significant efficacy and induce central neuroplastic changes.
• BCST is an effective treatment for RCC, likely by modulating interoceptive processing and inhibitory control.

Conclusions:

• RCC shares neurophysiological underpinnings with other central hypersensitivity disorders, suggesting shared therapeutic principles.
• Behavioral interventions like BCST offer a promising alternative to pharmacological treatments by engaging multiple neural pathways.
• Further research into the mechanisms of BCST and interoception-based therapies is crucial for advancing RCC treatment and patient outcomes.