title: Refractory chronic cough, or the need to focus on the relationship between the larynx and the esophagus.
abstract: In this review we question the current way of handling tackle a problem of chronic cough, especially by the excessive number of patients who can not find complete relief from your cough by anatomical diagnosis of universal use. From the field of Otolaryngology new perspectives arise now considering the larynx as a preferential afferent stimuli cough reflex arc. Also the constitution laryngopharyngeal reflux gas and new approaches to non-acid reflux and the local action of pepsin in laryngeal deserving of a joint review, which can illuminate new ways to handle the problem of chronic refractory cough. We believe that the chronic cough syndrome hpersensitivity as more precise label for chronic cough, should place particular emphasis on laryngeal sensory neuropathy as cough and reflux the influence that may have on their maintenance, and thereby causes definitely wide related to the syndrome if the larynx is incorporated, place greater number of afferent nerves of chronic cough, which are sure to cover much of the case of refractory cough remain without a satisfactory solution. The close collaboration between Otolaryngology, Gastroenterology and Pneumology in a patient with refractory chronic cough seems now an unavoidable necessity.
authors.affiliation: Chronic Cough Unit, Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain. doctorpachecogalvan@gmail.com.
authors.forename: Adalberto
authors.initials: A
authors.lastname: Pacheco
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cobeta
references.citation: Chest. 2005 May;127(5):1710-3
references.pmid: 15888850
references.citation: Thorax. 2006 Dec;61(12):1065-9
references.pmid: 16844725
references.citation: Laryngoscope. 2003 Nov;113(11):1927-30
references.pmid: 14603049
references.citation: J Voice. 2011 Sep;25(5):596-601
references.pmid: 21051202
references.citation: Laryngoscope. 2004 Dec;114(12):2129-34
references.pmid: 15564833
references.citation: Otolaryngol Clin North Am. 2010 Feb;43(1):15-25, vii
references.pmid: 20172253
references.citation: J Voice. 1999 Sep;13(3):447-55
references.pmid: 10498060
references.citation: J Pain. 2002 Apr;3(2):137-42
references.pmid: 14622800
references.citation: Laryngoscope. 2007 Jun;117(6):1036-9
references.pmid: 17417109
references.citation: Am J Respir Crit Care Med. 2004 Dec 15;170(12):1276-80
references.pmid: 15447941
references.citation: Arch Bronconeumol. 2011 Apr;47(4):195-203
references.pmid: 21459504
references.citation: Pulm Pharmacol. 1996 Oct-Dec;9(5-6):389-92
references.pmid: 9232683
references.citation: Thorax. 2003 Aug;58(8):699-702
references.pmid: 12885989
references.citation: Am J Respir Crit Care Med. 2011 Mar 15;183(6):708-15
references.pmid: 21148722
references.citation: Otolaryngol Clin North Am. 2010 Feb;43(1):67-72, viii
references.pmid: 20172257
references.citation: Am J Med. 2006 May;119(5):e13-5
references.pmid: 16651037
references.citation: Laryngoscope. 2000 Sep;110(9):1462-6
references.pmid: 10983943
references.citation: Pulm Pharmacol Ther. 2011 Jun;24(3):267-71
references.pmid: 21292019
references.citation: Pulm Pharmacol Ther. 2011 Jun;24(3):295-9
references.pmid: 21272660
references.citation: Respir Physiol Neurobiol. 2006 Jul 28;152(3):223-42
references.pmid: 16740418
references.citation: Otolaryngol Head Neck Surg. 2002 Dec;127(6):501-11
references.pmid: 12501100
references.citation: J Physiol. 2005 Dec 1;569(Pt 2):559-73
references.pmid: 16051625
references.citation: Laryngoscope. 2006 Dec;116(12):2108-12
references.pmid: 17146380
references.citation: Curr Opin Allergy Clin Immunol. 2007 Feb;7(1):37-42
references.pmid: 17218809
references.citation: Gastroenterology. 2008 Oct;135(4):1383-1391, 1391.e1-5
references.pmid: 18789939
references.citation: Pulm Pharmacol Ther. 2009 Apr;22(2):59-64
references.pmid: 19049891
references.citation: Lung. 2012 Feb;190(1):3-9
references.pmid: 22186805
references.citation: Am J Otolaryngol. 2001 Jul-Aug;22(4):251-6
references.pmid: 11464321
references.citation: Respir Med. 2007 Feb;101(2):345-8
references.pmid: 16787744
references.citation: Handb Exp Pharmacol. 2009;(187):23-47
references.pmid: 18825334
references.citation: Laryngoscope. 2001 Aug;111(8):1313-7
references.pmid: 11568561
references.citation: Am J Hum Genet. 2003 Sep;73(3):632-7
references.pmid: 12870133
references.citation: J Physiol. 2008 Dec 1;586(23):5771-86
references.pmid: 18832423
references.citation: Am J Gastroenterol. 2004 Jun;99(6):1000-10
references.pmid: 15180717
references.citation: Brain. 2005 Dec;128(Pt 12):2797-810
references.pmid: 16311270
references.citation: Gut. 2002 Jan;50(1):19-24
references.pmid: 11772961
references.citation: Laryngoscope. 2010 Aug;120(8):1576-81
references.pmid: 20564660
references.citation: Am J Gastroenterol. 1999 Jun;94(6):1464-7
references.pmid: 10364008
references.citation: Ann Otol Rhinol Laryngol. 2009 Apr;118(4):247-52
references.pmid: 19462843
references.citation: Chest. 2010 Jan;137(1):177-84
references.pmid: 20051402
references.citation: Laryngoscope. 2008 Feb;118(2):367-70
references.pmid: 18000464
references.citation: Thorax. 2005 Jun;60(6):488-91
references.pmid: 15923249
references.citation: J Clin Gastroenterol. 2009 May-Jun;43(5):414-9
references.pmid: 19197196
references.citation: Chest. 2006 Jan;129(1 Suppl):25S-27S
references.pmid: 16428688
references.citation: J Allergy Clin Immunol. 2004 Dec;114(6):1471-2
references.pmid: 15577854
references.citation: Chest. 2005 Feb;127(2):550-7
references.pmid: 15705995
references.citation: Pediatrics. 2007 Oct;120(4):855-64
references.pmid: 17908773
references.citation: Chest. 2006 Jan;129(1 Suppl):1S-23S
references.pmid: 16428686
references.citation: Eur Respir J. 2004 Sep;24(3):481-92
references.pmid: 15358710
references.citation: Ann Otol Rhinol Laryngol. 2005 Apr;114(4):253-7
references.pmid: 15895778
references.citation: Respirology. 2011 Aug;16(6):994-9
references.pmid: 21651646