Mini-review: Hypertussivity and allotussivity in chronic cough endotypes

Abstract

In recent years our understanding of the neurophysiological basis of cough has increased substantially. In conjunction, concepts around the drivers of chronic coughing in patients have also significantly evolved. Increasingly it is recognised that dysregulation of the neuronal pathways mediating cough play an important role in certain phenotypes of chronic cough and therefore pathological processes affecting the nervous system are likely to represent key endotypes in patients. Taking inspiration from the study of neuropathic pain, the term hypertussia has been employed to describe the phenomenon of abnormal excessive coughing in response to airway irritation and allotussia to describe coughing in response to stimuli not normally provoking cough. This review aims to summarise current clinical evidence supporting a role for the hyperexcitability of neuronal pathways contributing to chronic coughing and suggest how these might align with the clinical features observed in patients.