Somatic points for cough and urge to cough in chronic coughers

Somatically evoked cough responses help to identify patients with difficult-to-treat chronic cough: a six-month observational cohort study

“…To our knowledge, this is the first study to investigate the clinical relevance of somatically evoked cough or UTC in a real-life population of adult patients with chronic cough referred to a tertiary care centre in Italy. These results confirm previous observations 5 , 6 , 7 regarding a high percentage of SPC+ individuals among chronic coughers (particularly females), the anatomical distribution of SPCs in the upper trunk and neck, and the characteristics of the evoked responses. More importantly, symptom-driven treatments of cough-associated symptoms almost invariably resulted in a marked reduction of symptoms other than cough itself in both SPC+ and SPC− patients.…”

“…First, the mechanical actions of our experiments involved body areas that are anatomically and functionally different. 6 , 7 For instance, finger pressure on flabby areas of the neck might have stimulated the sensory endings of the underlying larynx, thereby provoking cough. Conversely, pressure on the sternum or cervico-dorsal spine is unlikely to have stimulated a sensory pathway for cough.…”

“…In all patients, we attempted to evoke coughing and/or the sensation of an UTC via finger pressure on the previously described 5 , 6 somatic points for cough (SPC), i.e., discrete body areas in the upper trunk or neck that can give rise to a UTC sensation or overt coughing in response to finger pressure, flexion or extension in chronic coughers. 5 , 6 These stimulation techniques are described in more detail in the online supplement ( Supplementary Fig. S1 ).…”

“…and interrater reliability was determined by kappa statistics. 6 Manoeuvres were repeated twice, and a cough or UTC response was taken as positive only if it appeared with both stimulations. The onset of cough was detected aurally; patients rated the intensity of the evoked UTC by using a visual analogue scale (VAS) ranging from 0 (no UTC at all) to 9 (maximum UTC).…”

“… 4 Sensory dysregulation may also explain another clinical feature of chronic coughers which often makes patients complain of an urge-to-cough (UTC) or overt coughing in response to mechanical stimuli that operate on discrete areas of the neck and upper trunk. 5 , 6 , 7 While this form of sensory dysregulation is frequent, 5 , 6 to ascertain this, we set out to investigate, in an unselected population of chronic coughers, the prevalence and clinical relevance of somatically evoked cough, 5 , 6 i.e., the cough and/or the sensation of an UTC triggered by mechanical stimuli, namely finger pressure, on regions of the upper chest and neck. 5 , 6 We have hypothesised that chronic coughers with somatically evoked cough present different clinical outcomes compared to patients who are devoid of this sensory dysregulation.…”