title: Mechanisms of cough.
abstract: OBJECTIVE
  To review recent developments in the mechanisms of chronic cough.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
authors.forename: Jodie L
authors.initials: JL
authors.lastname: Simpson
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Ryan
authors.forename: Anne E
authors.initials: AE
authors.lastname: Vertigan
mesh_terms: D000996:Antitussive Agents / Q000627:therapeutic use; D016535:Bronchial Hyperreactivity; D001991:Bronchitis / Q000453:epidemiology* / Q000628:therapy; D003371:Cough / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D004804:Eosinophils / Q000276:immunology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007830:Larynx / Q000378:metabolism / Q000473:pathology; D058990:Molecular Targeted Therapy; D009434:Neural Pathways; D018377:Neurotransmitter Agents / Q000627:therapeutic use; D009504:Neutrophils / Q000276:immunology*; D050051:Transient Receptor Potential Channels / Q000378:metabolism
chemical_list: D000996:Antitussive Agents; D018377:Neurotransmitter Agents; D050051:Transient Receptor Potential Channels