Weinberger Miles, Anbar Ran D, Buettner Dennis
Rady Children's Hospital, University of California San Diego, San Diego, CA 92123, USA.
Center Point Medicine, La Jolla, CA 92037, USA.
J Clin Med. 2025 Sep 18;14(18):6594. doi: 10.3390/jcm14186594.
Chronic cough without explanation or diagnosis has been described in medical books for over 300 years. Since 1977, some comorbidities, such as gastroesophageal reflux and post-nasal drip, have been attributed to be causes of otherwise unexplained chronic cough. Since 2005, publications have reported that unexplained chronic cough could be a distinct entity refractory to usual treatment. This was explained by dysregulation of cough centers involving the brainstem, subcortical, and cortical areas for which a neuromodulator would be essential for treatment. However, an 1886 publication described this disorder as a type of involuntary habit, and recommended treatment to break the habit. Supporting this alternative paradigm were studies that showed the urge to cough may have resulted from local airway inflammation with increased mucosal nerve density caused by the frequent daily coughing. The result was a vicious cycle where coughing caused the urge to cough, leading to repetitive daily coughing. Treatment has been demonstrated by a behavioral technique that breaks the habit. That behavioral technique, called suggestion therapy, has been highly successful in children and is now recognized as the standard of care for this disorder at pediatric referral centers. The proof of concept that suggestion therapy is effective in adults with refractory chronic cough has been demonstrated in selected adults but is not yet a common practice at specialty cough centers.
300多年来，医学书籍中一直记载着原因不明或未经诊断的慢性咳嗽。自1977年以来，一些合并症，如胃食管反流和鼻后滴漏，被认为是导致不明原因慢性咳嗽的原因。自2005年以来，有出版物报道，不明原因的慢性咳嗽可能是一种对常规治疗无效的独特病症。这是由于涉及脑干、皮层下和皮层区域的咳嗽中枢失调所致，对此神经调节剂对治疗至关重要。然而，1886年的一篇出版物将这种疾病描述为一种不由自主的习惯，并建议通过治疗来打破这种习惯。支持这一替代范式的研究表明，咳嗽冲动可能源于局部气道炎症，频繁的日常咳嗽导致黏膜神经密度增加。结果形成了一个恶性循环，咳嗽引发咳嗽冲动，导致每日反复咳嗽。一种打破习惯的行为技术已被证明可用于治疗。这种行为技术称为暗示疗法，在儿童中非常成功，现在在儿科转诊中心被认为是这种疾病的标准治疗方法。暗示疗法对难治性慢性咳嗽成人有效的概念验证已在部分成人中得到证实，但在专科咳嗽中心尚未成为常见做法。
