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Changing the paradigm for cough: does 'cough hypersensitivity' aid our understanding?

Song WJ, Chang YS, Morice AH - Asia Pac Allergy (2014)

Bottom Line: Over the last few decades, we have experienced significant clinical success by applying the paradigm of 'evaluating and treating the causes for chronic cough'.Commonly associated conditions such as rhinitis, eosinophilic bronchitis, asthma, or gastroesophageal acidic reflux may not be fundamental to cough, and thus may be triggers rather than causes.We suggest the new paradigm 'cough hypersensitivity syndrome' should finally bring us further advances in understanding and management of chronic cough.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea.

ABSTRACT
Chronic cough is a common reason for patients to seek medication attention. Over the last few decades, we have experienced significant clinical success by applying the paradigm of 'evaluating and treating the causes for chronic cough'. However, we still ask ourselves 'what underlies chronic cough. Indeed in a considerable proportion of patients cough is idiopathic, or unexplained despite vigorous evaluation. Commonly associated conditions such as rhinitis, eosinophilic bronchitis, asthma, or gastroesophageal acidic reflux may not be fundamental to cough, and thus may be triggers rather than causes. The cardinal feature of chronic cough is persistent upregulation the cough reflex, which may be driven by complex interactions between biologic, neurologic, immunologic, genetic, comorbid, and environmental factors. We suggest the new paradigm 'cough hypersensitivity syndrome' should finally bring us further advances in understanding and management of chronic cough.

No MeSH data available.


Related in: MedlinePlus

Captopril-induced cough reflex sensitization. Dose-response curve for capsaicin challenge up to a maximum response of 30 coughs/min; round, captopril; square, placebo. Values shown are mean and standard error of the mean. Reprinted from Morice AH, et al. Lancet 1987;2:1116-8, with permission of Elsevier [70].
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Figure 3: Captopril-induced cough reflex sensitization. Dose-response curve for capsaicin challenge up to a maximum response of 30 coughs/min; round, captopril; square, placebo. Values shown are mean and standard error of the mean. Reprinted from Morice AH, et al. Lancet 1987;2:1116-8, with permission of Elsevier [70].

Mentions: Clinically, chronic cough is observed to be predominant among middle-aged women, with homogeneity across various regions; peak age of onset appears to be perimenopausal, and the female ratio is twice that of male [68]. We also found that the demographic characteristics were significantly associated with capsaicin cough sensitivity, but not with eosinophilic bronchitis or rhinitis, in an unselected sample of Korean adult patients [29]. These findings could suggest that the development of cough sensitivity is a biologic phenomenon and also an intrinsic factor to determine cough response to any given stimulation. Higher prevalence of angiotensin converting enzyme inhibitor (ACEi) induced cough among females [69] also supports the notion. ACEi medication induces left-shifts in tussigen-induced cough responses (Fig. 3) [70], by promoting the accumulation of endogenous TRP agonists such as PG, BK or substance P [71]. Then, why do females develop more cough hypersensitivity than males?


Changing the paradigm for cough: does 'cough hypersensitivity' aid our understanding?

Song WJ, Chang YS, Morice AH - Asia Pac Allergy (2014)

Captopril-induced cough reflex sensitization. Dose-response curve for capsaicin challenge up to a maximum response of 30 coughs/min; round, captopril; square, placebo. Values shown are mean and standard error of the mean. Reprinted from Morice AH, et al. Lancet 1987;2:1116-8, with permission of Elsevier [70].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921869&req=5

Figure 3: Captopril-induced cough reflex sensitization. Dose-response curve for capsaicin challenge up to a maximum response of 30 coughs/min; round, captopril; square, placebo. Values shown are mean and standard error of the mean. Reprinted from Morice AH, et al. Lancet 1987;2:1116-8, with permission of Elsevier [70].
Mentions: Clinically, chronic cough is observed to be predominant among middle-aged women, with homogeneity across various regions; peak age of onset appears to be perimenopausal, and the female ratio is twice that of male [68]. We also found that the demographic characteristics were significantly associated with capsaicin cough sensitivity, but not with eosinophilic bronchitis or rhinitis, in an unselected sample of Korean adult patients [29]. These findings could suggest that the development of cough sensitivity is a biologic phenomenon and also an intrinsic factor to determine cough response to any given stimulation. Higher prevalence of angiotensin converting enzyme inhibitor (ACEi) induced cough among females [69] also supports the notion. ACEi medication induces left-shifts in tussigen-induced cough responses (Fig. 3) [70], by promoting the accumulation of endogenous TRP agonists such as PG, BK or substance P [71]. Then, why do females develop more cough hypersensitivity than males?

Bottom Line: Over the last few decades, we have experienced significant clinical success by applying the paradigm of 'evaluating and treating the causes for chronic cough'.Commonly associated conditions such as rhinitis, eosinophilic bronchitis, asthma, or gastroesophageal acidic reflux may not be fundamental to cough, and thus may be triggers rather than causes.We suggest the new paradigm 'cough hypersensitivity syndrome' should finally bring us further advances in understanding and management of chronic cough.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea.

ABSTRACT
Chronic cough is a common reason for patients to seek medication attention. Over the last few decades, we have experienced significant clinical success by applying the paradigm of 'evaluating and treating the causes for chronic cough'. However, we still ask ourselves 'what underlies chronic cough. Indeed in a considerable proportion of patients cough is idiopathic, or unexplained despite vigorous evaluation. Commonly associated conditions such as rhinitis, eosinophilic bronchitis, asthma, or gastroesophageal acidic reflux may not be fundamental to cough, and thus may be triggers rather than causes. The cardinal feature of chronic cough is persistent upregulation the cough reflex, which may be driven by complex interactions between biologic, neurologic, immunologic, genetic, comorbid, and environmental factors. We suggest the new paradigm 'cough hypersensitivity syndrome' should finally bring us further advances in understanding and management of chronic cough.

No MeSH data available.


Related in: MedlinePlus