Chronic cough is a difficult problem for both the patient and the physician. We have discussed before that the three most common categories for persistent cough are: nasosinus disease, GI problems – most commonly reflux, and lung disease. However, chronic cough can often remain refractory to conventional disease specific therapies and current cough suppressing medications. Most patients with chronic cough have a heightened sensitivity and experience a persistent need to cough. This hypersensitivity has led to the concept of something call “cough hypersensitivity syndrome” or CHS. This syndrome incorporates the neuronal mechanisms associated with cough as well as sensitization and dysfunction of the cough mechanism. Development of this line of thinking about cough has led to significant research into ways in which chronic cough can be helped.
Keep in mind that cough is a normal and protective function of the body and therapies that totally suppress the cough mechanism can be harmful. Consider in this context the patient who has had a stroke that has affected the throat and voice box. They are unable to sense the presence of food or saliva in the back of their throats and are at high risk for aspiration and pneumonia. On the plus side, knowing the mechanism of chronic cough can lead to targeted therapies for patients unresponsive to conventional treatments. Fortunately, most patients do respond to the usual and customary therapies as long as an accurate diagnosis is made and effective therapy is offered. Response varies and patients, indeed, need to be patient.
