Cough in chronic lung disease: a state of the art review

Abstract

Chronic cough (CC; ≥8 weeks in duration) is a common and burdensome feature of respiratory diseases. The understanding of cough has progressed significantly in recent years, albeit largely in refractory (unexplained) chronic cough (RCC) in the absence of other respiratory conditions. The prevalence of CC in respiratory diseases is poorly described, but estimates have been reported: asthma (8–58%), chronic obstructive pulmonary disease (COPD; 10–74%), bronchiectasis (82–98%), interstitial lung disease (ILD; 50–89%) and sarcoidosis (3–64%). CC in respiratory conditions generally predicts impaired health status and more severe disease. It is associated with increased symptom burden and disease severity in asthma, COPD, bronchiectasis and ILD, higher exacerbation frequency in asthma and bronchiectasis, and increased mortality and lung transplantation in idiopathic pulmonary fibrosis (IPF). Physiologically, heightened cough reflex sensitivity (CRS) has been reported and postulated to be mechanistic in isolated RCC. Cough reflex hypersensitivity (CRH) has also been reported in asthma, COPD, bronchiectasis, ILD and sarcoidosis. Unlike recent advances in isolated RCC, there are limited studies and understanding of central cough neuropathways in other respiratory conditions. Of note, dysfunctional central voluntary cough suppression neuropathways and physiology were observed in isolation in RCC; cough suppression is preserved in COPD. Understanding in the mechanism of RCC cannot be simply extrapolated to other respiratory conditions. The restricted understanding of cough mechanisms in these conditions has limited cough-specific therapeutic options in this context. There is currently an unmet need to expand our understanding of cough in chronic respiratory conditions, both in order to improve the quality of life of patients, and to improve knowledge of cough in general. This review aims to describe the prevalence, impact, pathophysiology and management of CC in asthma, COPD, bronchiectasis, ILD and sarcoidosis.

Exploring the Common Genetic Underpinnings of Chronic Pulmonary Disease and Esophageal Carcinoma Susceptibility

“…Prior observational studies have noted epidemiologic connections between esophageal carcinoma and chronic respiratory illnesses including COPD, IPF, and asthma, suggesting potential shared environmental or behavioral factors 34 - 38 . For example, several large cohort studies found a significantly heightened risk of esophageal cancer among COPD patients compared to controls without airflow obstruction 5 , 39 .…”

Chronic cough associated with COPD exacerbation, pneumonia and death in the general population

“…However, in these patients the effectiveness of therapy with novel antitussive drugs such as P2X3 antagonists has not been proved yet. Instead, the results of this study are good premises to treat patients (especially COPD patients) with productive chronic cough more intensely with mucolytics, antibiotics or bronchodilators [ 3 , 24 – 26 ]. We have an existing therapy, azithromycin, which has been shown in several studies to reduce exacerbation rates, and it is recommended in the ERS and CHEST cough guidelines [ 3 , 25 ].…”

“…Azithromycin has also been tested for other chronic cough-related diseases beyond COPD, e.g. in sarcoidosis cough, idiopathic pulmonary fibrosis cough and asthmatic cough, but with differing results [ 24 , 27 – 29 ].…”

The many faces of a cough in a child: Issues of differential diagnosis and treatment

“…Необходимо помнить, что причины длительного, хронического кашля различны для взрослых и детей [9][10][11]. Длительный кашель у ребенка в сочетании с другими дополнительными симптомами (одышка при физической нагрузке, гнойная мокрота, рецидивирующее свистящее дыхание, дефицит массы тела, задержка роста, быстрая утомляемость, стеаторея, деформация грудной клетки) всегда является признаком развития серьезного хронического заболевания бронхолегочной системы [12][13][14].…”