Chronic Cough Diagnosis and Management Strategies
Summary
Chronic cough, defined as a cough lasting more than eight weeks, represents a complex clinical challenge with multiple potential aetiologies and significant impact on quality of life. A systematic diagnostic pathway begins with a detailed clinical history and physical examination, focusing on upper airway cough syndrome, asthma, gastro-oesophageal reflux disease and non-asthmatic eosinophilic bronchitis. Objective investigations include spirometry, bronchial provocation tests, exhaled nitric oxide measurement and imaging studies to exclude structural or infiltrative lung disease. When standard evaluation is inconclusive, cough reflex sensitivity testing may help to characterise neural hypersensitivity. Management strategies combine targeted treatment of identified causes with neuromodulatory approaches and behavioural interventions. Pharmacological options range from antireflux agents and anti-inflammatories to novel neuromodulators such as P2X3 receptor antagonists. Non-pharmacological approaches, notably behavioural cough suppression therapy, emphasise retraining of sensory perception and voluntary control. Multidisciplinary collaboration ensures individualised care, addresses comorbidities and supports patients through education and self-management techniques. Emerging research into neuro-immune interactions and sensory nerve phenotyping promises further refinement of personalised therapies and improved long-term outcomes.
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Chronic Cough Diagnosis and Management Strategies publication trend
The graph below shows the total number of articles in chronic cough diagnosis and management strategies across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic refractory cough: A persistent cough unresponsive to standard treatment of underlying conditions.
Cough hypersensitivity syndrome: A paradigm describing chronic cough arising from heightened sensitivity of airway sensory nerves to stimuli.
Transient receptor potential channels (TRPV1, TRPA1): Ion channels on airway nerves that mediate cough reflex responses to chemical and physical triggers.
Behavioural cough suppression therapy (BCST): A non-pharmacological intervention teaching patients techniques to reduce cough frequency and intensity.
Leicester Cough Questionnaire (LCQ): A validated patient-reported outcome measure assessing the impact of chronic cough on quality of life.
References
- Long-term prognosis of chronic cough: a prospective, observational cohort study. BMC Pulmonary Medicine (2017).
- Evaluation and Management Outcomes and Burdens in Patients with Refractory Chronic Cough Referred for Behavioral Cough Suppression Therapy. Lung (2021).
- Heterogeneity of cough hypersensitivity mediated by TRPV1 and TRPA1 in patients with chronic refractory cough. Respiratory Research (2019).
- Cough hypersensitivity as a neuro‐immune interaction. Clinical and Translational Allergy (2015).
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