The central regulatory network of cough: a cornerstone of cough management

Coughing is a common reflex physiologic phenomenon that protects the respiratory system and removes secretions or foreign bodies from the airways. However, in some cases, coughing can become excessive and problematic, evolving into a bothersome symptom. Some patients with respiratory or non-respiratory conditions continue to cough even after the underlying cause has been eliminated and other symptoms have disappeared. This persistent cough, often characterized by increased sensitivity of the cough reflex and difficulty suppressing it, can disrupt daily life and potentially lead to further health issues. An increasing body of research indicates that the underlying neural mechanisms regulating cough production are complex, partly due to its heterogeneity across populations, with potential possibilities such as alterations in excitability or threshold regulation of central nervous circuits. These reasons may lead to the transformation of different cough symptoms in some respiratory and non-respiratory conditions into chronic coughs that are difficult to treat, and understanding these mechanisms could pave the way for targeted therapeutic strategies. This review explores current knowledge about the central regulatory network of cough, the links between different coughs and central regulatory mechanisms, and the factors that influence the effective treatment of cough (both clinical and research aspects) to inspire future research directions.