CHEST Guidelines-The-Problem-of-Treating-Unexplained-Chronic-Cough

The-Problem-of-Treating-Unexplained-Chronic-Cough_

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Unexplained chronic cough (UCC) is a challenging condition for both patients and physicians due to the lack of an identifiable medical cause and ineffective treatment options. Although it's not life-threatening, UCC can significantly impair social activities and quality of life. Traditional medications for conditions such as asthma or COPD often fail to address the symptoms of UCC, leading to frustration for those affected. <br /><br />Recent insights suggest a new approach may be more effective: treating UCC as part of "cough hypersensitivity syndrome" (CHS), where patients have heightened sensitivity to triggers like thermal, mechanical, or chemical stimuli. This parallels conditions in other organ systems, such as chronic pain and itch, which may have neuropathic origins.<br /><br />Recent studies highlight the role of transient receptor potential (TRP) ion channels, which play a key role in the cough reflex and may serve as potential therapeutic targets. Approaches are evolving to include peripheral and central desensitization strategies involving TRP inhibitors and other neuromodulatory drugs, as demonstrated by positive effects from gabapentin and pregabalin, particularly when combined with speech therapy.<br /><br />The research also suggests the use of nonpharmacologic treatments, like cough suppression techniques in speech therapy, which can be effective alongside drug treatments. Centrally acting medications such as codeine and morphine have been noted to affect cough reflex control, although they come with side effects. A study by Vertigan et al. reported that combining pregabalin with speech therapy significantly improved cough severity and quality of life for patients with UCC.<br /><br />New guidelines are in development to update treatment protocols for chronic cough, emphasizing a systematic, research-guided approach. The guidelines aim to create uniform terminology and treatment policies for UCC, considering both pharmacologic and nonpharmacologic strategies.

Keywords

Unexplained chronic cough

cough hypersensitivity syndrome

TRP ion channels

neuromodulatory drugs

gabapentin

pregabalin

speech therapy

treatment guidelines

nonpharmacologic treatments

cough reflex