Chronic cough - defined as a cough that persists for more than 8 weeks in adults - is a pervasive condition that affects around 12-13% of the adult population. Upwards variations can be attributed to environmental factors, healthcare access, and diagnostic criteria. 

Chronic cough is often called “unexplained chronic cough” because no clear underlying cause is identified, despite thorough investigation using historical clinical evaluation approaches. It is also referred to as “refractory chronic cough” because the cough does not respond to standard medication. 

One thing is certain: Chronic coughers typically undergo extensive testing without a definitive diagnosis and continue to experience symptoms despite undergoing various therapies for multiple successive identified causes.

Chronic cough is often debilitating. On average, cough tracking app users cough 20 times per hour, with some coughers coughing over a thousand times every day. 

Chronic cough is often accompanied by additional symptoms that include throat clearing, hoarseness, chest discomfort, shortness of breath, vomiting, and even incontinence and broken ribs. Sufferers often refuse to go out, pick up the phone or socialize in any way. A survey of cough tracking app users showed that 20% of coughers have had their cough for 10 years or longer.

Causes and Risk Factors

Historically, chronic cough was not regarded as a disease itself but as a symptom of various potential causes. With emerging evidence - much of it facilitated by the prevalence of new-generation cough quantification tools, such as those built by Hyfe - this perception is changing and experts are beginning to approach chronic cough as a stand-alone disease.

To make things more complicated for coughers and their medical providers, the etiology of chronic cough is multifaceted, involving various medical conditions and environmental factors. Some of the medical conditions closely related to chronic cough include:

• Asthma: particularly cough-variant asthma, where cough is the predominant symptom rather than wheezing.
• Gastroesophageal Reflux Disease (GERD): Acid reflux can irritate the throat and airways, leading to a persistent cough.
• Post-Nasal Drip: Also known as upper airway cough syndrome, it involves mucus dripping down the throat from the nasal passages, triggering a cough reflex.
• Allergies: Exposure to allergens such as pollen, dust, and pet dander can trigger a chronic cough in sensitive individuals.
• Exposure to Pollutants: Airborne pollutants, including smoke, chemicals, and particulate matter, can irritate the respiratory tract, leading to chronic coughing.

Available Treatment Options

There is no pharmaceutical treatment specifically designed for chronic cough. In fact there is hardly any treatment for cough itself - the most recent molecule approved by the FDA to treat cough has been Dextromethorphan, approved in 1958. No other medicine has been approved by the FDA since. Essentially, treating and management of chronic cough is challenging and frustrating for both patient and provider.

There is a new generation of cough molecules that is being researched currently, but mostly due to incumbent unreliable cough measuring tools, generating sufficient clinical evidence has been difficult. Off-label use of neuromodulator drugs (e.g., gabapentin, amitriptyline) have been shown to be helpful for some patients but side effects are often intolerable and benefits of the drug may wane over time. Throat injections designed to either block throat sensation or weaken the vocal folds have also been tried with some benefit but also come with side effects and usually require repeated treatments.

Some of the non-medical treatments commonly employed by chronic coughers involve dietary modifications, environmental controls (reducing exposure to allergens, pollutants, etc).

In extreme cases, coughers even resort to invasive medical choices such as nerve surgery or Botox Injections.

However, some of the most exciting evidence about cough managementis coming from the world of speech pathology, in the form of Behavioral Cough Suppression Therapy

The Hyfe Mind