Understanding cough
Reviewed by Sangeeta Maini and Bhaskar Ram

The prevalence of chronic cough in the adult population is 10–12%. Chronic cough is common and costly, and represents a substantial clinical and economic burden. Duration-based classification guides evaluation. Distinguishing acute (<3 weeks), subacute (3–8 weeks), and chronic (>8 weeks) cough remains clinically useful for narrowing differential diagnoses and guiding workup. Acute and subacute cough is typically managed by addressing the inciting infection or exposure, whereas chronic cough often requires targeting the sensitised neural pathways that perpetuate the reflex. The concept of cough hypersensitivity syndrome represents a paradigm shift in understanding chronic cough, recognising it as a distinct clinical entity characterised by neuronal dysfunction rather than simply a symptom of underlying disease. Peripheral sensitisation is defined as increased responsiveness of primary afferent neurons to stimulation. This is seen clinically as cough caused by typically nontussive factors such as talking, laughing, eating and even changes in body position. Central sensitisation of cough occurs when central neurons become more responsive to afferent input, thereby increasing the sensitivity of the cough reflex and allowing it to be activated by stimuli that would not otherwise elicit cough. The discovery of mechanisms of central and peripheral sensitisation has provided a neurobiological framework for understanding chronic cough, guiding the direction of new therapeutics aimed at specific molecular pathways. This article is excellent reading for ENT surgeons and, in fact, any physician managing patients with cough. We feel that understanding cough pathophysiology is key to a more scientific approach to cough management.

Pathophysiology of Cough.
Giannaris PS, Kaplan SE.  
OTOLARYNGOL CLIN NORTH AM
2026;59(4):701–18.