Chronic cough — treament in line with guidelines

Abstract

Chronic cough is one of the most common symptoms in clinical practice that is associated numerous negative consequences. The pathophysiology of chronic cough is complex, and its most common causes include respiratory diseases, neurological disorders, exposure to tobacco smoke, and medications. Understanding the physiology of cough and the mechanisms of cough hypersensitivity can improve the outcome of the treatment. At the turn of 2019 and 2020, the European Respiratory Society (ERS) issued guidelines concerning diagnostic evaluation and therapeutic management (pharmacological and non-pharmacological treatment) of chronic cough that persists despite causal treatment as well as cough of unknown etiology. The aim of the treatment, preceded by a thorough clinical evaluation, is to control the cough reflex while maintaing the protective function of cough. The following aspects should be taken into account in therapeutic management: antiasthmatic medications, medications reducing gastric acidity as well as prokinetic and neuromodulatory medications. Non-pharmacological methods include physiotherapy and speech therapy. To improve treatment results, it is necessary to seek new antitussive medications and physiotherapy methods, understand cough phenotypes and introduce more effective methods of cough measurement. Due to the limited efficacy of the currently used medications, researchers are currently conducting clinical trials involving new antitussive medications, with mechanisms of antitussive activity other than the ones which are currently applied.