Behavioural cough suppression therapy: a twisting journey to frontline therapy for refractory chronic cough

Extract Chronic cough, defined as a cough persisting for ≥8 weeks, affects an estimated 5–10% of the global population 1. After exclusion of underlying lung disease per clinical guidelines 2, a significant proportion of chronic cough patients undergo empiric therapy for gastro-oesophageal reflux, cough-variant asthma and upper airway cough syndrome with variable success. For a substantial proportion of patients, cough persists after appropriate work-up and treatment, leading to the diagnostic label of refractory cough (RCC) 3. In recent years, there has been a major shift in the conceptual understanding of RCC as disorder characterised by an increased propensity to cough in response to both tussive and nontussive stimuli. This phenomenon, recognised as cough hypersensitivity 4, has refocused the clinical lens through which chronic cough is assessed, explained and managed.