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

Chronic cough has traditionally been defined by its duration and regarded mainly as a symptom of underlying diseases. However, growing evidence suggests that in a substantial proportion of individuals, chronic cough persists despite adequate treatment of comorbid conditions and may reflect an underlying neuro-pathophysiological process, particularly cough reflex hypersensitivity. The treatable traits framework offers a structured and personalized approach by identifying clinically relevant, measurable, and modifiable traits to guide therapy. Recognition of cough hypersensitivity as a key treatable trait has been pivotal in shifting the perspective toward chronic cough as a distinct disease entity. This review summarizes the clinical relevance, diagnostic tools, therapeutic strategies, and supporting evidence for treatable traits in chronic cough and proposes a stratified application of the treatable traits model, prioritizing actionable traits based on evidence and resources. Beyond guiding treatment, this framework serves as a lens through which to interpret the multifactorial nature of chronic cough. We advocate for moving away from potentially misleading terminology such as "idiopathic", "unexplained", or "refractory". Instead, we propose reclassifying chronic cough based on identifiable traits. This shift supports the recognition of chronic cough as a distinct disease entity defined by specific mechanisms (e.g., neural dysregulation), as well as a symptom secondary to other conditions. Such an evolution is essential to align clinical practice and nosology with current scientific understanding.