Journal
BRITISH MEDICAL BULLETIN
Volume 96, Issue 1, Pages 61-73Publisher
OXFORD UNIV PRESS
DOI: 10.1093/bmb/ldq034
Keywords
chronic cough; neurophysiology; urge to cough; peripheral and central sensitization
Categories
Funding
- Moulton Charity
- Vitalograph UK
- GlaxoSmithKline
- Proctor and Gamble
- NIHR Translational Research Facility in Respiratory Medicine
- Medical Research Council [G0701918] Funding Source: researchfish
- MRC [G0701918] Funding Source: UKRI
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Chronic cough is common, blights patients' lives and is hard to treat. Chronic cough patients demonstrate high objective cough rates and as a group have increased cough reflex sensitivity. However, conventional cough challenge techniques show substantial overlap with normal subjects. This suggests that other important mechanisms have yet to be determined. For the last two decades, chronic cough has been considered to be caused by gastro-oesophageal reflux, post-nasal drip or Asthma. However, many patients with these conditions do not have cough, and in those with cough, the response to specific treatments is unpredictable at best. In addition, many chronic cough patients do not have an identifiable cause. This raises questions about the concept of a triad of treatable causes for chronic cough. Our current understanding of the neurophysiology of the cough reflex is largely derived from animal work with limited data in humans. By analogy with chronic pain syndromes, both peripheral and central sensitization may be important mechanisms in chronic cough, and are under active investigation. We need to understand the mechanisms underlying sensitization, how they interact with cough triggers and their relationship with the sensations that drive the urge to cough, and the subsequent motor cough response in chronic cough. Only then will we develop effective interventions.
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