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Cough Hypersensitivity Syndrome Is an Important Clinical Concept: A Pro/Con Debate

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Abstract

The major etiologies of chronic cough are generally accepted to consist of upper airway cough syndrome (formerly postnasal drip syndrome), eosinophilic airway inflammation (asthma, nonasthmatic eosinophilic bronchitis), and gastroesophageal reflux disease (GERD). However, only a small percentage of patients with these very common conditions suffers from chronic cough. Furthermore, acute cough due to viral upper respiratory tract infection (URI) is almost always a transient, self-limited condition, yet in a small subgroup of patients, URI heralds the onset of chronic, refractory cough. The cough hypersensitivity syndrome has been proposed to explain the occurrence of chronic cough in a subgroup of patients exposed to the same putative triggers as the vast majority of the population in whom chronic cough does not result. Although conceptually the cough hypersensitivity syndrome may be intellectually satisfying, differences of opinion remain as to whether this newly recognized entity is of clinical significance, i.e., useful for the treatment of patients suffering from chronic cough. The Third American Cough Conference, held in New York in June 2011, provided an ideal forum for the debate of this issue between two internationally recognized authorities in the field of cough.

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References

  1. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE et al (2006) Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):1S–23S

    Article  PubMed  Google Scholar 

  2. Morice AH, Fontana GA, Sovijarvi ARA, Pistolesi M, Chung KF, Widdicombe J et al (2004) The diagnosis and management of chronic cough. Eur Respir J 24:481–492

    Article  PubMed  CAS  Google Scholar 

  3. Morice AH (2010) The cough hypersensitivity syndrome: a novel paradigm for understanding cough. Lung 188:S87–S90

    Article  PubMed  CAS  Google Scholar 

  4. Chung KF (2011) Chronic ‘cough hypersensitivity syndrome’: a more precise label for chronic cough. Pulm Pharmacol Ther 24:267–271

    Article  PubMed  CAS  Google Scholar 

  5. Morice AH, Faruqi S, Wright CE, Thompson R, Bland JM (2011) Cough hypersensitivity syndrome: a distinct clinical entity. Lung 189:73–79

    Article  PubMed  CAS  Google Scholar 

  6. Morice AH, Lowry R, Brown MJ, Higenbottam T (1987) Angiotensin converting enzyme and the cough reflex. Lancet 2:1116–1118

    Article  PubMed  CAS  Google Scholar 

  7. Ternesten-Hasseus E, Farbrot A, Lowhagen O, Millqvist E (2002) Sensitivity to methacholine and capsaicin in patients with unclear respiratory symptoms. Allergy 57:501–507

    Article  PubMed  CAS  Google Scholar 

  8. Dicpinigaitis PV, Bhat R, Rhoton WA, Tibb AS, Negassa A (2011) Effect of viral upper respiratory tract infection on the urge-to-cough sensation. Respir Med 105:615–618

    Article  PubMed  Google Scholar 

  9. Phua SY, McGarvey L, Ngu M, Ing A (2010) The differential effect of gastroesophageal reflux disease on mechanostimulation and chemostimulation of the laryngopharynx. Chest 138:1180–1185

    Article  PubMed  Google Scholar 

  10. Groneberg DA, Niimi A, Dinh QT, Cosio B, Hew M, Fischer A et al (2004) Increased expression of transient receptor potential vanilloid-1 in airway nerves of chronic cough. Am J Respir Crit Care Med 170:1276–1280

    Article  PubMed  Google Scholar 

  11. Mitchell JE, Campbell AP, New NE, Sadofsky LR, Kastelik JA, Mulrennan SA et al (2005) Expression and characterization of the intracellular vanilloid receptor (TRPV1) in bronchi from patients with chronic cough. Exp Lung Res 31:295–306

    Article  PubMed  CAS  Google Scholar 

  12. Sadofsky LR, Campi B, Trevisani M, Compton SJ, Morice AH (2008) Transient receptor potential vanilloid-1-mediated calcium responses are inhibited by the alkylamine antihistamines dexbrompheniramine and chlorpheniramine. Exp Lung Res 34:681–693

    Article  PubMed  CAS  Google Scholar 

  13. Birrell MA, Belvisi MG, Grace M, Sadofsky L, Faruqi S, Hele DJ et al (2009) TRPA1 agonists evoke coughing in guinea-pig and human volunteers. Am J Respir Crit Care Med 180:1042–1047

    Article  PubMed  CAS  Google Scholar 

  14. Patterson N, Mainie I, Rafferty G, McGarvey L, Heaney L, Tutuian R et al (2009) Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol 43:414–419

    Article  PubMed  Google Scholar 

  15. Fathi H, Moon T, Donaldson J, Jackson W, Sedman P, Morice AH (2009) Cough in adult cystic fibrosis: diagnosis and response to fundoplication. Cough 5:1

    Article  PubMed  Google Scholar 

  16. Crooks MG, Hart SP, Morice AH (2011) Azithromycin for prevention of exacerbations of COPD (letter). N Engl J Med 365:2234–2235

    Article  PubMed  Google Scholar 

  17. McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M et al (1998) Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax 53:738–743

    Article  PubMed  CAS  Google Scholar 

  18. Millqvist E (2011) The airway sensory hyperreactivity syndrome. Pulm Pharmacol Ther 24:263–266

    Article  PubMed  CAS  Google Scholar 

  19. Birring SS (2011) Controversies in the evaluation and management of chronic cough. Am J Respir Crit Care Med 183:708–715

    Article  PubMed  Google Scholar 

  20. Fontana GA (2008) Before we get started: what is a cough? Lung 186(Suppl 1):S3–S6

    Article  PubMed  Google Scholar 

  21. Morice AH (2008) Rebuttal: cough is an expiratory sound. Lung 186(Suppl 1):S7–S9

    Article  PubMed  Google Scholar 

  22. Shannon R, Baekey DM, Morris KF, Nuding SC, Segers LS, Lindsey BG (2004) Production of reflex cough by brainstem respiratory networks. Pulm Pharmacol Ther 17:369–376

    Article  PubMed  CAS  Google Scholar 

  23. Bolser DC (2009) Central mechanisms II: pharmacology of brainstem pathways. Handb Exp Pharmacol 187:203–217

    Article  PubMed  CAS  Google Scholar 

  24. Canning BJ, Mori N (2010) An essential component to brainstem cough gating identified in anesthetized guinea pigs. FASEB J 24:3916–3926

    Article  PubMed  CAS  Google Scholar 

  25. Mazzone SB, Cole LJ, Ando A, Egan GF, Farrell MJ (2011) Investigation of the neural control of cough and cough suppression in humans using functional brain imaging. J Neurosci 31:2948–2958

    Article  PubMed  CAS  Google Scholar 

  26. Morice AH, Fontana GA, Belvisi MG, Birring SS, Chung KF, Dicpinigaitis PV et al (2007) ERS guidelines on the assessment of cough. Eur Respir J 29:1256–1276

    Article  PubMed  CAS  Google Scholar 

  27. Wright CE, Jackson J, Thompson RL, Morice AH (2010) Validation of the ERS standard citric acid cough challenge in healthy adult volunteers. Cough 6:8

    Article  PubMed  Google Scholar 

  28. Marsden PA, Smith JA, Kelsall AA, Owen E, Naylor JR, Webster D et al (2008) A comparison of objective and subjective measures of cough in asthma. J Allergy Clin Immunol 122:903–907

    Article  PubMed  Google Scholar 

  29. Prudon B, Birring SS, Vara DD, Hall AP, Thompson JP, Pavord ID (2005) Cough and glottic-stop reflex sensitivity in health and disease. Chest 127:550–557

    Article  PubMed  Google Scholar 

  30. Kamimura M, Mouri A, Takayama K, Mizutani T, Hamamoto Y, Iikura M et al (2010) Cough challenge tests involving mechanical stimulation of the cervical trachea in patients with cough as a leading symptom. Respirology 15:1244–1251

    Article  PubMed  Google Scholar 

  31. Gunthorpe MJ, Chizh BA (2009) Clinical development of TRPV1 antagonists: targeting a pivotal point in the pain pathway. Drug Discov Today 14:56–67

    Article  PubMed  CAS  Google Scholar 

  32. Gavva NR, Treanor JJ, Garami A, Fang L, Surapaneni S, Akrami A et al (2008) Pharmacological blockade of the vanilloid receptor TRPV1 elicits marked hyperthermia in humans. Pain 136:202–210

    Article  PubMed  CAS  Google Scholar 

  33. Van Oudenhove L, Vandenberghe J, Vos R, Holvoet L, Tack J (2011) Factors associated with co-morbid irritable bowel syndrome and chronic fatigue-like symptoms in functional dyspepsia. Neurogastroenterol Motil 23:524–e202

    Article  PubMed  Google Scholar 

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Correspondence to Peter V. Dicpinigaitis.

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Morice, A.H., McGarvey, L.P.A. & Dicpinigaitis, P.V. Cough Hypersensitivity Syndrome Is an Important Clinical Concept: A Pro/Con Debate. Lung 190, 3–9 (2012). https://doi.org/10.1007/s00408-011-9351-y

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  • DOI: https://doi.org/10.1007/s00408-011-9351-y

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