Chronic cough as a disease

Abstract

Chronic cough is a frequent reason for medical consultation and has significant impact on quality of life. Due to the limited effectiveness of currently available treatments, and delays in accessing care, patients are often inadequately managed. There remains an overreliance by clinicians on outdated management algorithms, addressing chronic cough only as symptom of other medical conditions, and advocating investigation and trials of treatment of diseases which are often not present. This may lead to unnecessary cost, frustration and potential harm. Newer clinical guidelines in essence consider chronic cough as a disease in itself, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. Secondary factors which aggravate chronic cough (smoking, asthma, gastro-oesophageal reflux, etc.) are better considered as treatable traits associated with the primary disease process rather than direct "causes" of cough. Explicitly approaching chronic cough as a discrete entity is consistent with the way in which "diseases" are generally characterised, and has advantages. The patient should be better able to understand their condition, and may have better confidence in attempts at management. The clinician should have better focus and avoid unfruitful treatments and investigation. In general, considering chronic cough as a disease should help to raise the profile of the condition, improve organisation of health service pathways, increase attention for research, and further the development of new treatments.

FIGURE 1

A model of chronic cough: three main components.