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Pharmacological Management of Cough

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Diagnosis and Treatment of Chronic Cough

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Abstract

The pharmacological management of chronic cough is largely stagnated for the past 40 years. Drug development in acute cough has also been hampered because, despite the burgeoning market in over-the-counter remedies, the drugs used are generic, and so any claims of efficacy made can be utilised by competitor products. Thus there has been a paucity of high-quality trials due to lack of investment. Small trials of centrally acting neuromodulators such as low-dose opiates and gabapentin have demonstrated some efficacy. Drugs acting on the aetiological factors for chronic cough such as montelukast for eosinophilic bronchitis and azithromycin for oesophageal dysmotility have also demonstrated some efficacy in these phenotypes of chronic cough. However there is still no licensed medication for the indication of refractory chronic cough.

It is only with the realisation that chronic cough is a separate disease characterised by hypersensitivity of the afferent vagus that investment in high-quality studies has been made. The finding that antagonism of the purinergic receptor P2X3 reduced cough counts has established chronic cough as a therapeutic opportunity. Gefapixant, the first in class P2X3 antagonist, has now successfully completed phase 3 studies. On the back of this success, three other new chemical entities are in late-stage development. The central role of substance P in the cough reflex has been confirmed by positive clinical studies of orvepitant an NK1 receptor blocker. Other potential therapeutic pathways include sodium channel blockade and TRPM8 agonists.

It is thus a very exciting time in the therapeutics of chronic cough. Treatment of this chronic, common and disabling condition is advancing in parallel with our understanding of the complex neural pathways relaying the aberrant noxious sensation provoking cough.

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Authors and Affiliations

  1. Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK

    Kayleigh Brindle & Alyn Morice

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  1. Kayleigh Brindle
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  2. Alyn Morice
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Correspondence to Alyn Morice .

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Editors and Affiliations

  1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (Republic of)

    Sang Heon Cho

  2. Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)

    Woo-Jung Song

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Brindle, K., Morice, A. (2021). Pharmacological Management of Cough. In: Cho, S.H., Song, WJ. (eds) Diagnosis and Treatment of Chronic Cough. Springer, Singapore. https://doi.org/10.1007/978-981-33-4029-9_7

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  • DOI: https://doi.org/10.1007/978-981-33-4029-9_7

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