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Chronic cough in adults

  • Antonio Spanevello
    Affiliations
    Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy

    Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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  • Bianca Beghé
    Affiliations
    Department of Medicine, Section of Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
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  • Dina Visca
    Affiliations
    Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Tradate, Tradate, Varese, Italy

    Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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  • Leonardo M. Fabbri
    Correspondence
    Corresponding author at: Azienda Ospedaliera Universitaria Sant’Anna, Department of Medical Sciences, Section of Cardiorespiratory and Internal Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy.
    Affiliations
    Azienda Ospedaliera Universitaria, Department of Medical Sciences, Section of Cardiorespiratory and Internal Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
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  • Alberto Papi
    Affiliations
    Azienda Ospedaliera Universitaria, Department of Medical Sciences, Section of Cardiorespiratory and Internal Medicine, University of Ferrara, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
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      Highlights

      • Cough is a defense mechanism for clearing the airways but may become troublesome.
      • Chronic cough of known and unknown cause(s) frequently requires medical attention.
      • Chronic cough of known cause(s) must be treated according to guidelines.
      • Chronic refractory cough may benefit from neuromodulatory/speech pathology therapy.
      • Novel promising neuromodulatory agents are in clinical development.

      Abstract

      Cough, a defense mechanism for clearing the airways of secretions, exudate, or foreign bodies, may become a troublesome symptom. Chronic cough, one of the most frequent symptoms requiring medical attention, is often not due to identifiable causes in adults. Chronic productive cough defines chronic bronchitis, and thus is present in 100% of these patients, and frequently in patients with bronchiectasis, cystic fibrosis, and chronic infectious respiratory diseases. However, chronic cough is most frequently dry. Thus, chronic cough in adults is a difficult syndrome requiring multidisciplinary approaches, particularly to diagnose and treat the most frequent identifiable causes, but also to decide which patients may benefit by treating the central cough hypersensitivity by neuromodulatory therapy and/or non-pharmacologic treatment (speech pathology therapy). Recent guidelines provide algorithms for diagnosis and assessment of cough severity; particularly chronic cough in adults. After excluding life-threatening diseases, chronic cough due to identifiable causes (triggers and/or diseases), particularly smoking and/or the most frequent diseases (asthma, chronic bronchitis, chronic obstructive pulmonary disease, eosinophilic bronchitis, and adverse reactions to drugs [angiotensin-converting enzyme inhibitors and sitagliptin]) should be treated by avoiding triggers and/or according to guidelines for each underlying disease. In patients with troublesome chronic cough due to unknown causes or persisting even after adequate avoidance of triggers, and/or treatment of the underlying disease(s), a symptomatic approach with neuromodulators and/or speech pathology therapy should be considered. Additional novel promising neuromodulatory agents in clinical development (e.g., P2X3 inhibitors) will hopefully become available in the near future.

      Keywords

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