Chronic Idiopathic Cough

Abstract

Cough: A convulsion of the lungs, vellicated by some sharp serosity. It is pronounced coff. Samuel Johnson Unaided except by amanuenses, Johnson was justly famed for authoring the magisterialDictionary of the English Language(1755), the source of this definition (vellicate = twitch or pluck; serosity = a serous surface). Until succeeded by theOxford English Dictionary, it remained the acknowledged standard reference for more than a century. A nonsmoker, Johnson died a respiratory death; at autopsy, he was found to have emphysema and cor pulmonale.1Reich JM Convulsion of the lung: an historical analysis of the cause of Dr. Johnson's fatal emphysema..J Roy Soc Med. 1994; 87: 737-741PubMed Google ScholarThe severity of his cough and its potential contribution to his malady is conveyed by his vivid description of it as a “convulsion.” In noting that “… the act of coughing itself may be responsible for the denudation and other histopathologic findings…” in persons with chronic idiopathic cough, and that these findings were indistiguishable from bronchial biopsies in persons with defined intrapulmonary and extrapulmonary sources of cough, the authors2Irwin RS Owmbey R Cagle PT et al.Interpreting the histopathology of chronic cough..Chest. 2006; 130: 362-370Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholarassert the likelihood that these findings were the consequence, not the cause, of the observed cough. Implicit, I think, in this conclusion is the possibility that some instances of idiopathic chronic cough represent the tracheobronchial counterpart of neurodermatitis,ie, that chronic cough is self sustaining; that, mediated by respiratory trauma, it begets cough. If this interpretation is correct, it follows that a sustained trial of drug-induced cough suppression would be a valid diagnostic and therapeutic strategy. ResponseCHESTVol. 131Issue 2PreviewThere are three issues embodied within Dr. Reich's letter that are deserving of comment. The first relates to his reference to Samuel Johnson, an important figure during the American revolutionary war period, who used language when describing and defining cough suggesting that the act of coughing had the potential to have severe and traumatic consequences and that this has been appreciated for at least hundreds of years. Full-Text PDF