Chronic cough: new concepts and therapeutic possibilities
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Cough is the most common symptom of the upper and lower airway diseases. In its nature, cough is a defence re-flex mechanism of the respiratory tract that is used to clear the upper and lower airways. Chronic cough, defined as cough lasting for more than 8 weeks, is reported in 3–40% of the general population and has an important impact on patients’ quality of life, by causing anxiety, physical discomfort, social isolation and personal emabarrassment, be-ing an often medical complaint and one of the most common reasons for outpatient visits. Upper airway cough syn-drome, asthma, eosinophilic bronchitis and gastroesophageal reflux diseases account for most chronic cough after excluding somking, angiotensin-converting enzyme inhibitor use and chronic bronchitis. Many patients have more than one reason for chronic cough. Some complex diagnostic procedures, in many individuals are necessary to rec-ognized the cause/causes of chronic cough and to establish the accurate diagnosis, which implies a higher chance of effective treatment. Despite detailed diagnostic procedures, in many cases, the efficacy of chronic cough treatment is questionable and ambiguous. We observe not always satisfactory response to therapy. There are some coughs that seem refractory despite an extensive work-up. The possibility of hypersenitive cough reflex response, defining pa-tients with Cough Hypersensitivity Syndrome has been proposed to explain these cases, rather resistant to cough treatment, previously known as idioapthic cough or refractory, unexplained cough. The concept of Cough Hypersen-sitivity Syndrome helps us to understand the mechanisms underlying cough and provides better therapeutic options to treat chronic cough, like neuromodulating drugs, and speech therapy.
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