Cough and cough hypersensitivity as treatable traits of asthma

Kefang Lai; Imran Satia; Woo-Jung Song; Gang Wang; Akio Niimi; Philip Pattemore; Anne B Chang; Peter G Gibson; Kian Fan Chung

doi:10.1016/S2213-2600(23)00187-X

Cough and cough hypersensitivity as treatable traits of asthma

Lancet Respir Med. 2023 Jul;11(7):650-662. doi: 10.1016/S2213-2600(23)00187-X. Epub 2023 Jun 16.

Authors

Kefang Lai¹, Imran Satia², Woo-Jung Song³, Gang Wang⁴, Akio Niimi⁵, Philip Pattemore⁶, Anne B Chang⁷, Peter G Gibson⁸, Kian Fan Chung⁹

Affiliations

¹ The First Affiliated Hospital of Guangzhou Medical University, National Center of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
² Department of Medicine, McMaster University, Hamilton, ON, Canada; Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.
³ Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital & Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, China.
⁵ School of Medical Sciences, Nagoya City University, Nagoya, Japan.
⁶ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
⁷ Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia.
⁸ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
⁹ National Heart and Lung Institute, Imperial College London, London, UK; Royal Brompton and Harefield Hospitals, London, UK. Electronic address: [email protected].

PMID: 37336227
DOI: 10.1016/S2213-2600(23)00187-X

Abstract

Cough is a common and troublesome symptom in people with asthma and is often associated with poorer asthma control and exacerbations. Apart from asthma, other causes or comorbidities might underlie cough in asthma, such as rhinosinusitis and bronchiectasis. Eosinophilic inflammation and bronchoconstriction can lead to an acute episode of cough or worsen chronic cough. Cough hypersensitivity with laryngeal paraesthesia, allotussia, and hypertussia might underlie the cough of asthma through augmented sensory nerve excitability of upper-airway vagal sensory nerves. Cough associated with bronchoconstriction and type 2 inflammation should respond to inhaled corticosteroids and long-acting β-adrenoceptor agonist therapy. For cough hypersensitivity in adults, speech and language therapy and neuromodulators (eg, gabapentin) could be considered. In children, there is no consistent association of asthma with cough sensitivity or between cough and asthma severity. Further research is needed to realise the potential of cough as a measure of asthma control, to understand the mechanisms of cough in asthma, and to develop safe, effective treatments and a precision-medicine approach to the management of cough in asthma in children and adults.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones
Adult
Asthma* / complications
Child
Chronic Disease
Cough* / etiology
Cough* / therapy
Humans
Inflammation

Substances

Adrenal Cortex Hormones