Song Woo-Jung, Manian Deepti Vellaichamy, Kim Yeonhee, Zhang Mengru, Morice Alyn H
Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Allergy and Immunology, Stormont Vail Health, Topeka, Kan.
J Allergy Clin Immunol Pract. 2025 Mar;13(3):469-478. doi: 10.1016/j.jaip.2024.10.046. Epub 2024 Nov 16.
Cough reflex hypersensitivity is emerging as a key treatable trait in chronic cough and other cough-associated respiratory conditions. This review examines the neurological basis of cough, highlighting the complex interplay between peripheral and central mechanisms. The concept of cough hypersensitivity aims to address unmet clinical needs by recognizing chronic cough as a distinct disorder rather than merely a symptom. Evidence from clinical trials supports cough hypersensitivity as a treatable trait in chronic cough, with opiates, gabapentinoids, and novel P2X3 antagonists showing efficacy. Cough hypersensitivity is also relevant in conditions presenting with persistent cough, such as asthma, bronchiectasis, and idiopathic pulmonary fibrosis, though more research is needed. Recognizing cough reflex hypersensitivity as a treatable trait offers new avenues for management, particularly for patients with persistent cough despite etiology-targeted therapies. We propose redefining chronic cough as a distinct disease entity in which cough hypersensitivity is a common feature and key therapeutic target, potentially leading to better patient care and the development of novel therapies.
咳嗽反射超敏反应正逐渐成为慢性咳嗽及其他与咳嗽相关的呼吸道疾病中一个关键的可治疗特征。本综述探讨了咳嗽的神经学基础，强调了外周和中枢机制之间复杂的相互作用。咳嗽超敏反应的概念旨在通过将慢性咳嗽视为一种独特的疾病而非仅仅是一种症状，来满足未被满足的临床需求。临床试验证据支持咳嗽超敏反应作为慢性咳嗽的一种可治疗特征，阿片类药物、加巴喷丁类药物和新型P2X3拮抗剂已显示出疗效。咳嗽超敏反应在伴有持续性咳嗽的疾病中也具有相关性，如哮喘、支气管扩张和特发性肺纤维化，不过仍需要更多研究。将咳嗽反射超敏反应视为一种可治疗特征为管理提供了新途径，特别是对于那些尽管接受了针对病因的治疗仍有持续性咳嗽的患者。我们建议将慢性咳嗽重新定义为一种独特的疾病实体，其中咳嗽超敏反应是一个共同特征和关键治疗靶点，这可能会带来更好的患者护理并推动新型疗法的开发。
