Cough hypersensitivity syndrome: clinical measurement is the key to progress

Morice, Alyn H.; Millqvist, Eva; Belvisi, Maria G.; Biekšienė, Kristina; Birring, Surinder S.; Chung, Kian Fan; Negro, Roberto W. Dal; Dicpinigaitis, Peter V.; Kantar, Ahmad; McGarvey, Lorcan; Pacheco, Adalberto; Sakalauskas, Raimundas; Smith, Jaclyn A.

doi:10.1183/09031936.00014215

Cited by 29 publications

(17 citation statements)

References 6 publications

(14 reference statements)

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“…There are few clinical measurement tools to define cough hypersensitivty 7576. In a study using objective cough frequency monitoring, the geometric mean total cough counts per 24 hours were 16.8 (log-standard deviation 0.5) in healthy subjects, 33 (0.6) in smokers, 107 (0.3) in asthmatic patients, 321 (0.3) in cough variant asthmatic/eosinophilic bronchitis patients, and 477 (0.3) in unexplained chronic cough patients 77.…”

Section: How To Measure Cough Hypersensitivitymentioning

confidence: 99%

“…However, the correlations between these subjective and objective indices are only moderate,83 suggesting that each represents different facets of cough. Indeed, patients with cough-related incontinence or life-threatening cough syncope may have only occasional paroxysms of coughing 76. Finally, a cough challenge test can be useful in phenotyping patients84 and studying therapeutic agents in relation to specific channels 70…”

Section: How To Measure Cough Hypersensitivitymentioning

confidence: 99%

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Cough Hypersensitivity Syndrome: A Few More Steps Forward

Song

Morice

2017

Allergy Asthma Immunol Res

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108

109

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Cough reflex is a vital protective mechanism against aspiration, but when dysregulated, it can become hypersensitive. In fact, chronic cough is a significant medical problem with a high degree of morbidity. Recently, a unifying paradigm of cough hypersensitivity syndrome has been proposed. It represents a clinical entity in which chronic cough is a major presenting problem, regardless of the underlying condition. Although it remains a theoretical construct, emerging evidence suggests that aberrant neurophysiology is the common etiology of this syndrome. Recent success in randomized clinical trials using a P2X3 receptor antagonist is the first major advance in the therapeutics of cough in the past 30 years; it at last provides a strategy for treating intractable cough as well as an invaluable tool for dissecting the mechanism underpinning cough hypersensitivity. Additionally, several cough measurement tools have been validated for use and will help assess the clinical relevance of cough in various underlying conditions. Along with this paradigm shift, our understanding of cough mechanisms has improved during the past decades, allowing us to continue to take more steps forward in the future.

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Section: How To Measure Cough Hypersensitivitymentioning

confidence: 99%

Section: How To Measure Cough Hypersensitivitymentioning

confidence: 99%

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Song

Morice

2017

Allergy Asthma Immunol Res

Self Cite

108

109

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“…The concept of cough hypersensitivity syndrome has been paid much attention to date, 3 and several causes of chronic cough have been regarded as the clinical phenotypes and/or triggers of cough hypersensitivity. 4,5 …”

Section: Introductionmentioning

confidence: 99%

Association of cough hypersensitivity with tracheal TRPV1 activation and neurogenic inflammation in a novel guinea pig model of citric acid-induced chronic cough

Chen

Qiu

et al. 2018

J Int Med Res

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ObjectiveThis study was performed to establish a novel model of citric acid-induced chronic cough in guinea pigs and to investigate the pathogenesis of cough hypersensitivity.MethodsHealthy conscious guinea pigs inhaled citric acid (0.4 M) for 3 minutes twice daily for 25 days. Cough reactivity was evaluated, substance P (SP) and calcitonin gene-related peptide (CGRP) in bronchoalveolar lavage fluid were detected, and transient receptor potential cation channel subfamily V member 1 (TRPV1) protein expression in the trachea and bronchus was determined. Tracheal and bronchial tissues were examined for TRPV1.ResultsInhalation of 0.4 M citric acid increased coughing in a time-dependent manner: coughing peaked at 15 days and reached the lowest level at 25 days. This was accompanied by similar changes in SP, CGRP, and TRPV1 protein expression. TRPV1 was mainly observed in the mucosal and submucosal layer of the trachea and bronchi. The areas of TRPV1 positivity in the trachea and bronchi of citric acid-treated animals were significantly larger than in the control group.ConclusionsRepeated inhalation of citric acid can be employed to establish a chronic cough model in guinea pigs. Cough hypersensitivity in this model is related to tracheal TRPV1 activation and neurogenic inflammation.

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“…A recent consensus statement has suggested the term 'cough hypersensitivity syndrome' be used to describe patients with chronic cough. 16 However, evidence from experimentally evoked cough suggests that the neuronal pathways exhibit hyper-responsiveness rather than hypersensitivity. 17 In pharmacokinetic terms, the dose response curve is predominantly shifted upwards with much less left-shift, ie the dose required to evoke a cough is marginally reduced, but the maximal number of coughs to a given stimulus is substantially increased (Fig 3 ).…”

Section: Neurophysiology Of Coughmentioning

confidence: 99%

Towards understanding and managing chronic cough

et al. 2016

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Chronic cough is a common and troublesome condition affecting approximately 12% of the general population. It is associated with poor quality of life with psychological, social and physical consequences. Patients typically complain of a dry irritating cough, driven by a strong urge to cough associated with a sensation or irritation located in the throat. Treatment of potential 'causes', ie asthma, gastro-oesophageal reflux disease and rhino-sinusitis, may produce a complete or partial response, but the response of some patients to opiates and alpha-2-delta ligand antagonists (gabapentin and pregabalin) supports the concept that this is primarily a neurological disorder, characterised by hyper-responsiveness of the nerves. Novel and highly effective neuronal treatments are in development and offer hope of better symptom control with fewer side effects within a few years. This review focuses on understanding the mechanism of chronic cough, current management approaches and research that may lead to novel therapies.

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Cough hypersensitivity syndrome: clinical measurement is the key to progress

Cited by 29 publications

References 6 publications

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Association of cough hypersensitivity with tracheal TRPV1 activation and neurogenic inflammation in a novel guinea pig model of citric acid-induced chronic cough

Towards understanding and managing chronic cough

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