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Mechanisms of cough

Gibson, Peter G.; Simpson, Jodie L.; Ryan, Nicole M.; Vertigan, Anne E.

Current Opinion in Allergy and Clinical Immunology: February 2014 - Volume 14 - Issue 1 - p 55–61
doi: 10.1097/ACI.0000000000000027
MECHANISMS OF ALLERGY AND ADULT ASTHMA: Edited by Jean Bousquet and J. Andrew Grant

Purpose of review To review recent developments in the mechanisms of chronic cough.

Recent findings Although cough prevalence is similar across the world, there are significant regional differences in the diseases associated with cough. This may represent regional differences in diet, environmental exposure, and diagnostic assessment and labelling. Cough can be reliably measured using several validated questionnaires and objective tools that monitor cough frequency and cough reflex sensitivity. Cough with eosinophilic bronchitis responds to anti-inflammatory therapy with corticosteroids and montelukast. The absence of airway hyperresponsiveness may be because of the release of a bronchoprotective mediator, prostaglandin E2. Cough with neutrophilic bronchitis is associated with rhinitis and gastroesophageal reflux disease. Laryngeal hypersensitivity (LHS) is an important new concept that explains cough mechanisms, identifies potentially new pharmacotherapies that target neural pathways and also transient receptor channels, and demonstrates how behavioural therapies can be effective in refractory cough. The concept also explains symptoms in a variety of related syndromes such as vocal cord dysfunction.

Summary New insights into cough mechanisms that focus on LHS help explain cough symptoms and the place of effective therapies including speech pathology intervention and neuromodulators.

aCentre for Asthma and Respiratory Diseases and Hunter Medical Research Institute, The University of Newcastle, Newcastle

bDepartment of Respiratory and Sleep Medicine, John Hunter Hospital

cDepartment of Speech Pathology, John Hunter Hospital, New Lambton, New South Wales, Australia

Correspondence to Dr Peter G Gibson, MBBS, FRACP, Level 2, HMRI, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW 2310, Australia. Tel: +61 240420143; e-mail: Peter.gibson@newcastle.edu.au

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