Chronic Cough Hypersensitivity as a Neuropathic Disorder: Implications for Management and New Treatments

Chronic cough can coexist with or without pulmonary and extrapulmonary conditions and can be refractory to therapies that improve these associated conditions. It is underlined by cough hypersensitivity, which is characterized by increased cough responses to stimuli that affect the airways and vagally innervated tissues as well as by excessive cough responses to innocuous stimuli, and it is caused by neuroinflammatory and neuropathic mechanisms at both peripheral and central levels. The management of chronic cough starts with exclusion of associated conditions, followed by use of neuromodulators and speech and language therapy. This is progressing toward personalized management, with new approaches to endotype to treat these patients with the introduction of novel antitussive therapies.