Experts discuss advances in understanding, management of chronic cough

Cough, as a protective reflex, can be helpful in clearing irritants, mucus, and pathogens from the lung and airways. But problems mount as symptoms persist. And despite advancements in the understanding of chronic cough—defined as lasting more than eight weeks—the condition remains challenging to diagnose and manage.

Experts discussed these complications and emerging opportunities for patients and their clinicians during the CHEST 2025 session Updates in Chronic Cough on Sunday, October 19, in Chicago.

“Chronic cough is hiding in plain sight. But that doesn’t mean that it doesn’t make an impact on the patient’s life,” said Munish Sharma, MD, FCCP, Session Co-Chair and Assistant Professor of Medicine at Baylor College of Medicine, Temple Campus.

While the exact prevalence of chronic cough is difficult to determine, chronic cough is estimated to affect 2% to 18% of adults globally, Dr. Sharma said. He noted that the condition affects the physical, psychological, social, and economic well-being of these patients, with 70% reporting sleep disturbances and 33% exhibiting anxiety symptoms. Individuals with chronic cough also experience impaired work productivity and increased health care utilization, he said.

Advances in pathophysiology and diagnosis

Shekhar Ghamande, MD, FCCP, Professor of Medicine at Baylor College of Medicine, Temple Campus, reviewed treatment targets and some of the newer paradigms for managing chronic cough.

The limited success of some ion channel antagonists in clinical trials suggests that cough hypersensitivity involves mechanisms beyond simple peripheral nociceptor stimulation. Recent findings have revealed the role of the central nervous system in chronic cough, characterized by central sensitization and impaired engagement of networks.

Dr. Ghamande also discussed recent updates in the diagnosis of chronic cough, including the treatable traits approach suggested by 2023 British Thoracic Society guidelines.

“A treatable trait is a therapeutic target identified by phenotypes or endotypes through a validated biomarker and amenable to treatment,” Dr. Ghamande said.

Besides reflux, some other treatable traits are underlying lung disease, anxiety, and inducible laryngeal obstruction. Further, obesity and OSA have been increasingly recognized as treatable traits.

Pharmacological innovations

Sumera Ahmad, MBBS, Assistant Professor of Pulmonary and Critical Care Medicine at the Mayo Clinic, discussed P2X3 antagonists, opiates, and neuromodulators for the treatment of chronic cough.

The first clinical trial of P2X3 antagonists in 2015 identified taste disturbance as an adverse effect. Following this, P2X3 antagonists were refined to be more specific to the P2X3 receptors on the airway epithelium rather than on the taste buds. In the clinical trial of camlipixant, the occurrence of taste disturbance was much lower than in previous trials.

In terms of opiates, recent evidence suggests that targeting kappa receptors may improve cough. Results from the RIVER phase 2 trial of nalbuphine demonstrated a significant reduction in cough frequency. However, there were side effects, including constipation, somnolence, and nausea, that clinicians should be prepared to address if prescribing this medicine.

In terms of neuromodulators, a study comparing gabapentin and baclofen showed similar efficacy with fewer side effects of somnolence and dizziness in the gabapentin-treated group.

Dr. Ahmad offered recommendations in conclusion.

“When we are doing clinical trials, it is important to include study design, the training of the providers, the treatment delivery, the treatment received, and the enactment of treatment,” Dr. Ahmad said.

Emerging role of AI

Session Chair Salim Surani, MD, MPH, MSc, FCCM, FCCP, Clinical Professor at the University of Houston, discussed artificial intelligence (AI) in the management of chronic cough.

AI acoustics can assist in diagnosing pulmonary diseases. A validation study of Hyfe AI cough monitoring showed a 90.4% sensitivity and 1.03 false positives per hour.

“We can also have a smartphone just like we have a pacemaker monitoring. We can actually have a physician’s office connected with our smartphone, and they can actually see how the coughs are doing. And AI can actually help us in predicting the cough and flare-ups,” Dr. Surani said.

Benefits of AI in acoustics include that it is objective, reproducible, and scalable. Additionally, it supports telemedicine and rural health care, enables early intervention, decreases hospitalizations, and facilitates continuous monitoring with wearables. Some challenges of using AI acoustics for diagnosis include ambient noise interference, variability in equipment, the need for large and diverse datasets, and regulatory approval and clinical validation issues.

“Imagine how much cost savings can be if you just cough in an app,” Dr. Surani said. “Millions of people can just get the diagnosis within a matter of a moment.”