title: Management of chronic refractory cough.
abstract: Chronic refractory cough (CRC) is defined as a cough that persists despite guideline based treatment. It is seen in 20-46% of patients presenting to specialist cough clinics and it has a substantial impact on quality of life and healthcare utilization. Several terms have been used to describe this condition, including the recently introduced term cough hypersensitivity syndrome. Key symptoms include a dry irritated cough localized around the laryngeal region. Symptoms are not restricted to cough and can include globus, dyspnea, and dysphonia. Chronic refractory cough has factors in common with laryngeal hypersensitivity syndromes and chronic pain syndromes, and these similarities help to shed light on the pathophysiology of the condition. Its pathophysiology is complex and includes cough reflex sensitivity, central sensitization, peripheral sensitization, and paradoxical vocal fold movement. Chronic refractory cough often occurs after a viral infection. The diagnosis is made once the main diseases that cause chronic cough have been excluded (or treated) and cough remains refractory to medical treatment. Several treatments have been developed over the past decade. These include speech pathology interventions using techniques adapted from the treatment of hyperfunctional voice disorders, as well as the use of centrally acting neuromodulators such as gabapentin and pregabalin. Potential new treatments in development also show promise.
authors.affiliation: Centre for Asthma and Respiratory Disease, University of Newcastle; Department of Respiratory and Sleep Medicine, John Hunter Hospital; Hunter Medical Research Institute, Newcastle, NSW, 2010, Australia peter.gibson@hnehealth.nsw.gov.au.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
authors.affiliation: Centre for Asthma and Respiratory Disease, University of Newcastle; Speech Pathology Department, John Hunter Hospital; Hunter Region Mail Centre, Hunter Medical Research Institute.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Vertigan
mesh_terms: D000223:Adaptation, Psychological; D000588:Amines / Q000627:therapeutic use*; D002908:Chronic Disease; D003371:Cough / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D000077206:Gabapentin; D006801:Humans; D018377:Neurotransmitter Agents / Q000627:therapeutic use*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013066:Speech-Language Pathology / Q000379:methods*; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use*
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D018377:Neurotransmitter Agents; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin