Abstract
ABSTRACT
Purpose
To summarize current Western and Eastern approaches to the evaluation and management of chronic cough, with particular emphasis on etiology‐directed therapy, cough hypersensitivity, behavioral interventions, neuromodulators, procedural treatments, and traditional remedies.
Methods
A literature search of PubMed, Web of Science, CNKI, and Ovid Medline was conducted on February 1, 2024. Adults with chronic cough lasting at least 8 weeks were eligible. Pediatric studies, studies involving immunocompromised patients, smokers or patients with lung cancer, animal studies, and non‐English or non‐Mandarin publications were excluded. Because of substantial heterogeneity in etiologies, interventions, study designs, and outcome measures, findings were synthesized narratively rather than quantitatively. Twenty‐three primary studies were included in the final narrative synthesis.
Results
Chronic cough commonly reflects cough hypersensitivity involving vagal sensory pathways and receptors including TRPV1, TRPA1, and P2X3. Common clinical contributors included upper airway cough syndrome, gastro‐esophageal reflux disease, and cough‐variant asthma. Management was most appropriately organized as a stepwise approach involving identification and treatment of the underlying cause, behavioral cough suppression therapy, and selected pharmacological treatment. Gabapentin and P2X3 antagonists may benefit refractory cough, although adverse effects and limited long‐term data remain important limitations. Superior laryngeal nerve block and antireflux surgery may be considered in carefully selected patients. Acupuncture and selected traditional preparations may provide adjunctive benefit, but the evidence remains heterogeneous and should not replace standard evaluation or treatment.
Conclusion
Chronic cough should be managed using a personalized, stepwise strategy that combines etiology‐directed treatment with interventions targeting cough hypersensitivity. Traditional therapies may have a complementary role, but further well‐designed comparative studies are required.