At the end of 2023, updated national clinical statements on chronic cough were released by both Australia and the UK, marking significant updates after 13 and 17 years, respectively. Chronic cough, defined as lasting 8 weeks or more, is common, especially among middle-aged women, and severely impacts quality of life.
The initial assessment of chronic cough should include clinical history, examination, and a chest X-ray to rule out acute infections, ACE inhibitor usage, and classical conditions such as asthma and gastroesophageal reflux disease (GERD). Further investigations may involve spirometry, a full blood count, fractional exhaled nitric oxide, and possibly a computed tomography scan based on red flags and risks for serious conditions.
Traditional management models, which focus primarily on asthma, GERD, and rhinosinusitis, are increasingly seen as inadequate. A new paradigm suggests that chronic cough may be a neuroinflammatory or neuropathic disorder, with cough hypersensitivity as a central issue. This model is supported by evidence such as increased airway sensory nerve fibers, patient-reported triggers, functional MRI findings, and similarities to CANVAS syndrome.
Recent advancements in treatment include repurposed medications like morphine, gabapentin, and pregabalin, as well as novel agents like P2X3 inhibitors (e.g., Gefapixant). Non-pharmacological approaches, such as behavioral techniques from speech therapists and respiratory physiotherapists, have also shown promise.
The clinical approach should focus on excluding serious causes to reassure patients, tailoring investigations to the clinical context, and avoiding empirical treatments without specific indications. Treatment should target identified treatable traits and the underlying issue of cough hypersensitivity.
The updated guidelines aim to improve systematic approaches, recognize chronic cough as a distinct disease, and enhance patient outcomes.
To know more
https://doi.org/10.1111/resp.14686