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Emerging Drugs for Chronic Cough

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Cough: Pathophysiology, Diagnosis and Treatment

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Abstract

Chronic cough, or cough lasting >8 weeks, is among the commonest clinical problems encountered by doctors both in general practice and in hospital. Chronic cough patients may have underlying medical conditions (i.e. asthma, upper-airway cough syndrome, gastro-oesophageal reflux) or they may have unexplained chronic cough where no associated medical condition can be identified. In refractory chronic cough patients, conventional treatment of underlying disorders is frustratingly inadequate in ameliorating bouts of coughing. Unfortunately, treatment of unexplained or refractory chronic cough remains a significant unmet medical need since no new therapy has been approved in several decades. However, our understanding of the pathophysiological basis of chronic cough has dramatically advanced over the past decade with the realisation that neuronal hypersensitivity underlies cough hypersensitivity syndrome. Much effort was devoted in the development of blockers of the nociceptors, mainly transient receptor potential channel, which are responsible for the irritant sensation leading to the tickle that precedes cough. Whilst effective in animal models these agents have failed in the clinic. ATP is released during cell damage and acts on afferent sensory nerves through P2X3 purinergic receptors. The first antagonist, Gefapixant, has been studied in several hundred patients with chronic cough with resolution in the majority. Other compounds in this class are in development. This chapter reviews emerging antitussive drugs that may down-regulate cough reflex sensitivity.

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Author information

Authors and Affiliations

  1. Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy

    Federico Lavorini, Guja Bernacchi & Alessio Fabbrizzi

Authors
  1. Federico Lavorini
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  2. Guja Bernacchi
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  3. Alessio Fabbrizzi
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Corresponding author

Correspondence to Federico Lavorini .

Editor information

Editors and Affiliations

  1. Cough Study and Treatment Centre, S.I.S.Me.R., Bologna, Italy

    Alessandro Zanasi

  2. Department of Critical Care, Medicine and Surgery, University of Florence, Florence, Italy

    Giovanni A. Fontana

  3. Department of Experimental and Clinical Medicine - Section of Physiology, University of Florence, Florence, Italy

    Donatella Mutolo

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Lavorini, F., Bernacchi, G., Fabbrizzi, A. (2020). Emerging Drugs for Chronic Cough. In: Zanasi, A., Fontana, G., Mutolo, D. (eds) Cough: Pathophysiology, Diagnosis and Treatment. Springer, Cham. https://doi.org/10.1007/978-3-030-48571-9_13

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  • DOI: https://doi.org/10.1007/978-3-030-48571-9_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48570-2

  • Online ISBN: 978-3-030-48571-9

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