Chronic Refractory Cough as a Sensory Neuropathy: Evidence From a Reinterpretation of Cough Triggers

SummaryObjectives/HypothesisThe aims of this study were to examine cough triggers in individuals with chronic cough (CC), identify sensory symptoms consistent with central reflex sensitization (paresthesia and allotussia), and interpret this information in relation to sensory laryngeal neuropathy.Study DesignProspective observational study.MethodsPatients (n = 53) with CC that was refractory to medical management based on the anatomic diagnostic protocol completed questionnaires regarding cough triggers, anxiety and depression, and factors contributing to laryngeal irritation such as vocal hygiene and laryngopharyngeal reflux.ResultsAn abnormal sensation in the laryngeal area (laryngeal paresthesia) was present in 94% of people with refractory CC. Nontussive stimuli including phonation were frequent triggers for cough (allotussia), occurring in 71% of participants. Although tussive stimuli were significantly more potent than nontussive stimuli (P = 0.005), the relative clinical importance was not statistically different (P = 0.072). Most participants with refractory cough had poor vocal hygiene.ConclusionThe sensory symptom changes that accompany CC suggest central reflex sensitization and include laryngeal paresthesia and allotussia. The results are consistent with cough as a sensory neuropathic disorder.