Endogenous central suppressive mechanisms regulating cough as potential targets for novel antitussive therapies

• Cough and the urge-to-cough are motor and sensory response to airway irritation.
• Voluntary cough suppression involves a fronto-basal ganglia neural circuit.
• Placebo cough suppression involves the dorsolateral prefrontal cortex.
• A descending antitussive circuit may suppress brainstem processing.
• Modulating central suppression could be considered in cough disorders.

Cough and the accompanying sensation known as the urge-to-cough are complex neurobiological phenomena dependent on sensory and motor neural processing at many levels of the neuraxis. In addition to the excitatory neural circuits that provide the positive drive for inducing cough and the urge-to-cough, recent studies have highlighted the existence of likely inhibitory central neural processes that can be engaged to suppress cough sensorimotor processing. In many respects, the balance between excitatory and inhibitory central cough control may be a critical determinant of cough in health and disease which argues for the importance of understanding the biology of these putative central inhibitory processes. This brief review summarises the current knowledge of the central circuits that govern voluntary and involuntary cough suppression and posits the notion of targeting central suppressive mechanisms as a treatment for disordered cough in disease.