Now is the Right Time to Establish a New Strategy for Managing Chronic Cough as a Neuropathic Disorder

373 http://e-aair.org No clinician would disagree with the fact that chronic cough is a very common and annoying clinical condition and is not so easy to treat as anticipated. Chronic cough is considerably heterogeneous in terms of clinical features and many possible underlying causative disorders. Indeed, managing chronic cough patients can be very tricky at times, especially when they show neither symptoms suggestive of certain disorders nor definite abnormalities in physical examination or chest X-rays. In consideration of its high prevalence and heterogeneity, several algorithmic approaches have been proposed for the diagnosis and management of chronic cough, though there have been no widely accepted guidelines, such as GINA for asthma. The proposed algorithms mostly focus on diagnosing underlying causative diseases, such as asthma, rhinosinusitis, gastroesophageal reflux disease (GERD), and laryngopharyneal reflux , which are the common causes of chronic cough. The question is: Do most coughing patients get better when clinicians mainly focus on identification of culprit disorders with the guidelines? Unfortunately, the answer would not be affirmative. A substantial proportion of patients continue to suffer from chronic cough despite proper treatment of underlying diseases, and a significant number of patients are regarded as so-called idiopathic chronic cough. Although chronic cough is an umbrella term encompassing various underlying diseases and the importance of searching for the specific diagnosis for each patient should not be ignored, diagnosing the underlying disease is definitely not sufficient to solve this bothersome problem. What is interesting in the article on this issue by Song et al. is that almost all chronic cough patients show symptoms strongly suggestive of neuropathy, namely hypertussivity to capsaicin and allotussivity to cold air regardless of underlying diseases, which are consistent with those of other previous studies. Those observations lead to a reasonable assumption that the same pathophysiologic mechanism may function to generate Now is the Right Time to Establish a New Strategy for Managing Chronic Cough as a Neuropathic Disorder