From symptom to disease: Reclassifying chronic cough through the treatable traits framework?

Area of Science:

• Pulmonology
• Neurology
• Clinical Medicine

Background:

• Chronic cough is often viewed as a symptom, but may involve neuro-pathophysiological processes like cough reflex hypersensitivity.
• Persistent cough despite treatment suggests an underlying issue beyond common comorbidities.
• The treatable traits framework offers a personalized approach to managing complex chronic cough.

Purpose of the Study:

• To review the clinical relevance, diagnostics, and therapeutics for treatable traits in chronic cough.
• To propose a stratified model for applying the treatable traits framework.
• To advocate for reclassifying chronic cough based on identifiable traits rather than vague terms.

Main Methods:

• Literature review on chronic cough, cough hypersensitivity, and the treatable traits framework.
• Analysis of diagnostic tools and therapeutic strategies for cough hypersensitivity.
• Synthesis of evidence supporting the treatable traits model for chronic cough.

Main Results:

• Cough hypersensitivity is recognized as a key treatable trait, shifting the view of chronic cough to a distinct disease entity.
• The treatable traits framework provides a structured method for personalized chronic cough management.
• Evidence supports a stratified application of the treatable traits model, prioritizing actionable traits.

Conclusions:

• Reclassifying chronic cough based on identifiable traits (e.g., neural dysregulation) aligns clinical practice with scientific understanding.
• The treatable traits framework aids in interpreting the multifactorial nature of chronic cough.
• Moving beyond terms like "idiopathic" or "refractory" is crucial for accurate diagnosis and effective treatment of chronic cough.