Satia Imran, Hassan Wafa, McGarvey Lorcan, Birring Surinder S
Department of Medicine, McMaster University, Hamilton, ON, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada.
J Allergy Clin Immunol Pract. 2025 Mar;13(3):454-466. doi: 10.1016/j.jaip.2024.11.004. Epub 2024 Nov 16.
Chronic cough remains a significant clinical challenge, affecting approximately 10% of the population and leading to significant impairment in psychological, social, and physical quality of life. In recent years, efforts have intensified to elucidate the mechanisms underlying chronic cough and to focus on investigating and treating refractory chronic cough (RCC). A "treatable trait" approach, which focuses on identifying and addressing the specific associated causes of chronic cough, has gained traction. In some patients, RCC is likely driven by a neuropathic mechanism due to dysregulation of the neuronal pathways involved in the cough reflex, often clinically described as cough hypersensitivity syndrome. Although the initial treatment of underlying conditions remains central to managing treatable traits, the therapeutic options for RCC have expanded to include targeting cough hypersensitivity. First-line treatments now include neuromodulators and speech therapy with one P2X3 receptor antagonist (gefapixant) recently licensed in the European Union, United Kingdom, and Japan. Despite these advances, patient responses remain variable, underscoring the ongoing need for research into the pathophysiology and treatment of RCC. This article reviews current investigations and management options in treating chronic cough and RCC.
慢性咳嗽仍然是一个重大的临床挑战，影响着约10%的人口，并导致心理、社会和身体生活质量的显著受损。近年来，人们加大了努力来阐明慢性咳嗽的潜在机制，并专注于难治性慢性咳嗽（RCC）的研究和治疗。一种“可治疗特征”方法，即专注于识别和解决慢性咳嗽的特定相关病因，已受到关注。在一些患者中，RCC可能由神经病理性机制驱动，这是由于参与咳嗽反射的神经元通路失调所致，临床上通常称为咳嗽高敏综合征。虽然针对潜在疾病的初始治疗仍然是管理可治疗特征的核心，但RCC的治疗选择已扩大到包括针对咳嗽高敏性。一线治疗现在包括神经调节剂和言语治疗，最近一种P2X3受体拮抗剂（gefapixant）已在欧盟、英国和日本获得许可。尽管有这些进展，但患者的反应仍然各不相同，这突出表明对RCC的病理生理学和治疗进行研究的持续必要性。本文综述了治疗慢性咳嗽和RCC的当前研究及管理选择。
