Cough and cough hypersensitivity as treatable traits of asthma

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.; Competing Interests: Declaration of interests KL declares honoraria from AstraZeneca, Chiesi, Circassia, Daiichi Sankyo (China), GSK, Merck, Shionogi, and Novartis, and grant and other support from AstraZeneca, Chiesi, Circassia, Daiichi Sankyo (China), GSK, and Merck. IS is currently supported by the EJ Moran Campbell Early Career Award, Department of Medicine at McMaster University (Hamilton, ON, Canada). IS reports grants and personal fees from Merck, GSK, and Bellus; grants from Bayer; and personal fees from Respiplus, Genentech, and AstraZeneca, outside the submitted work. W-JS declares academic grants from MSD; consulting fees from MSD, GSK, AstraZeneca, and Novartis; and honoraria from MSD, GSK, AstraZeneca, and Novartis. AN declares honoraria for lectures and presentations for AstraZeneca, Kyorin, Novartis, GSK, and Sanofi, and for participating on Advisory Boards of AstraZeneca, MSD, Kyorin, and Bayer. ABC declares funds to her institution from the National Health Medical Research Council (Australia) and BMJ Best Practice and personal funds from UpToDate. PGG reports personal fees for lectures from AstraZeneca, GSK, and Novartis, and grants from AstraZeneca and GSK. KFC has received honoraria for participating in advisory board meetings for Roche, Merck, Novartis, GSK, Nocion, Shionogi, and Rickett-Beckinson, and has also been renumerated for speaking engagements for Novartis and AstraZeneca. KFC organised the 12th International Cough Symposium in July, 2022, which received an educational grant from Merck. KFC has received research funding from GSK and Merck. GW and PP declare no competing interests. (Copyright © 2023 Elsevier Ltd. All rights reserved.)