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Prescribing the right therapy for the treatment of chronic cough: a critical focus on current and investigational options

Chronic cough is a debilitating condition resulting in patients coughing hundreds to thousands of times per day [1]. Although chronic cough has been defined in the 2000s as cough lasting for more than 8 weeks in adults and 4 weeks in children [2,3], according to the current European Respiratory Society (ERS) guidelines, defining a chronic cough on the basis of longevity is an evident arbitrary paradigm [4]. However, despite these definitions, there is no consensus on the real prevalence of chronic cough in the community, although it is estimated that around 12% of the general population may be affected and certainly cough remains one of the most common symptoms for which patients seek medical attention [5]. Chronic cough is an important symptom associated with several respiratory disorders, such as asthma, eosinophilic bronchitis, chronic obstructive pulmonary disease (COPD), postnasal drip syndrome, upper airway cough syndrome secondary to rhinosinus diseases, and interstitial lung diseases (ILDs), along with non-respiratory disorders such as gastroesophageal reflux disease (GORD), that should be ruled out or treated according to specific algorithms to assess whether chronic cough is a separate entity or it is related to other comorbidities [5,6]. For example, in certain patient populations, the use of drugs such as the angiotensin-converting enzyme (ACE) inhibitor for the treatment of hypertension may result in chronic cough as a frequent adverse event [6]. Moreover, but of no less importance, smoking habits can be a major remediable cause of chronic cough, most frequently in patients with COPD [4]. Unfortunately, the current investigations and treatment algorithms of chronic cough are mainly based on expert opinions or consensus, with few data originating from welldesigned randomized clinical trials (RCTs) [4,5]. Being a symptom and not a diagnosis, chronic cough should be considered itself a treatable trait of other disorders that often have not been yet diagnosed [7]. Thus, in the majority of patients from a pharmacological and clinical point of view, the first step to treat chronic cough is to diagnose and treat the underlying disease appropriately.