Cough in Severe Asthma

Abstract

Asthma is a heterogeneous clinical syndrome that presents with variable symptoms, including cough, breathlessness, chest discomfort, and wheezing. Cough, a primary symptom of asthma, has distinct regulatory mechanisms and was associated with asthma severity, poor asthma control, diminished quality of life, and an increased risk of frequent future exacerbations. However, current tools for measuring asthma control do not include separate items for cough or other specific symptoms, and the true impact and clinical relevance of cough in asthma remains poorly understood. Consequently, current stepwise treatment algorithms based on asthma control may be overly simplistic and might not adequately address the heterogeneity of asthma or the mechanisms underlying its symptoms. Furthermore, this approach carries the risk of overestimating asthma severity and subsequent overtreatment. The concept of treatable traits is fundamental to precision medicine, wherein each symptom, especially cough, may serve as a treatable trait in its own right. In this paper, we aim to present evidence supporting the concept of cough as a treatable trait in asthma, addressing its three major components, which are clinical relevance, measurability, and treatability.