Clinical features of the urge-to-cough in patients with chronic cough

Hilton, Emma; Marsden, Paul; Thurston, Andrew; Kennedy, Stephen; Decalmer, Samantha; Smith, Jaclyn A.

doi:10.1016/j.rmed.2015.03.011

Cited by 94 publications

(64 citation statements)

References 25 publications

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“…Cough is frequently preceded by an urge-to-cough, a sensation of irritation or itching in the throat, which is also called laryngeal paresthesia 31. The frequency of allotussia or urge-to-cough varies according to population and methodology, but it is reported to occur in ~99% of these patients 23453132. Moreover, these characteristics of cough are similar to those of pain, such as allodynia, which is the pain caused by stimuli that do not normally provoke pain 28.…”

Section: Evidence For Neuropathology In Cough Hypersensitivity Syndromementioning

confidence: 99%

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Song

Morice

2017

Allergy Asthma Immunol Res

116

110

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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: Evidence For Neuropathology In Cough Hypersensitivity Syndromementioning

confidence: 99%

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Song

Morice

2017

Allergy Asthma Immunol Res

116

110

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“…Patients with chronic cough report a consistent and characteristic sensory experience, which suggests a common somatosensory disturbance associated with the urge to cough and excessive coughing. 81 An assessment of cough triggers and the urge to cough can provide valuable information about the person's cough control. Formal exposure to potential triggers can be trialed in the clinical setting.…”

Section: Urge To Coughmentioning

confidence: 99%

Management of chronic refractory cough

Gibson

Vertigan

2015

BMJ

110

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Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.

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“…The urge-to-cough is a sensation that has a strong representation in the laryngeal airways of patients across a diversity of airways diseases and drives behavioral coughing to satiate the unpleasant sensation [44]. The urge-to-cough is most commonly described as an irritation or tickle in the back of the neck and is associated with >90% of coughs in patients with chronic cough[45]. Capsaicin inhalation evokes an urge-to-cough, which was associated with activations in a variety of brain regions relevant for cough [46].…”

Section: Sensitization Of Cough Reflex By Activation Of Sensory Nementioning

confidence: 99%

Cough reflex sensitization from esophagus and nose

Hennel

Brozmanová

Kollárik

2015

Pulmonary Pharmacology & Therapeutics

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The diseases of the esophagus and nose are among the major factors contributing to chronic cough although their role in different patient populations is debated. Studies in animal models and in humans show that afferent C-fiber activators applied on esophageal or nasal mucosa do not initiate cough, but enhance cough induced by inhaled irritants. These results are consistent with the hypothesis that activation of esophageal and nasal C-fibers contribute to cough reflex hypersensitivity observed in chronic cough patients with gastroesophageal reflux disease (GERD) and chronic rhinitis, respectively. The afferent nerves mediating cough sensitization from the esophagus are probably the neural crest-derived vagal jugular C-fibers. In addition to their responsiveness to high concentration of acid typical for gastroesophageal reflux (pH<5), esophageal C-fibers also express receptors for activation by weakly acidic reflux such as receptors highly sensitive to acid and receptors for bile acids. The nature of sensory pathways from the nose and their activators relevant for cough sensitization are less understood. Increased cough reflex sensitivity was also reported in many patients with GERD or rhinitis who do not complain of cough indicating that additional endogenous or exogenous factors may be required to develop chronic coughing in these diseases.

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Clinical features of the urge-to-cough in patients with chronic cough

Cited by 94 publications

References 25 publications

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Cough Hypersensitivity Syndrome: A Few More Steps Forward

Management of chronic refractory cough

Cough reflex sensitization from esophagus and nose

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