title: Chronic cough as a neuropathic disorder.
abstract: Chronic cough is a common symptom that can be a daunting challenge for clinicians since treatment of the underlying cause does not always provide adequate relief, an obvious cause can remain elusive, and current antitussives have fairly poor efficacy and undesirable side-effects. Patients with chronic cough typically describe a range of sensory symptoms suggestive of upper-airway and laryngeal neural dysfunction. Additionally, patients often report cough triggered by low-level physical and chemical stimuli, which is suggestive of cough-reflex hyperresponsiveness. Pathophysiological mechanisms underlying peripheral and central augmentation of the afferent cough pathways have been identified, and compelling evidence exists for a neuropathy of vagal sensory nerves after upper-respiratory viral infections or exposure to allergic and non-allergic irritants. In this Personal View, we argue that chronic cough is a neuropathic disorder that arises from neural damage caused by a range of inflammatory, infective, and allergic factors. In support of this idea, we discuss evidence of successful treatment of chronic cough with agents used for treatment of neuropathic pain, such as gabapentin and amitriptyline. Regarding cough as a neuropathic disorder could lead to new, more effective antitussives.
authors.affiliation: Experimental Studies Unit, National Heart & Lung Institute, Imperial College London, London, UK; Biomedical Research Unit, Royal Brompton Hospital, London, UK. Electronic address: f.chung@imperial.ac.uk.
authors.forename: Kian Fan
authors.initials: KF
authors.lastname: Chung
authors.affiliation: Centre for Infection and Immunity, The Queen's University of Belfast, Belfast, UK.
authors.forename: Lorcan
authors.initials: L
authors.lastname: McGarvey
authors.affiliation: Laboratory of Respiratory Neuroscience and Mucosal Immunity, School of Biomedical Sciences, The University of Queensland, St Lucia, QLD, Australia.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Mazzone
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D002908:Chronic Disease; D003371:Cough / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D012137:Respiratory System / Q000294:innervation / Q000503:physiopathology*
chemical_list: D000700:Analgesics