Dominic L. Sykes
The Cough Reflex: The Janus of Respiratory Medicine
Sykes, Dominic L.; Morice, Alyn H.
Authors
Professor Alyn Morice A.H.Morice@hull.ac.uk
Foundation Chair and Professor of Respiratory Medicine
Abstract
In clinical practice, we commonly face adversity when encountering dysfunction of the cough reflex. Similar to ancient Roman deity Janus, it often presents with one of two opposing “faces”. Continual aberrant activation of the cough reflex, also known as chronic cough, can cause great detriment to quality of life and many of these patients are left misdiagnosed and undertreated. In contrast, loss of normal functioning of the cough reflex is the cause of a significant proportion of mortality in the elderly, primarily through the development of aspiration pneumonia. In this review we discuss both hyper- and hypo-activation of the cough reflex and how airway reflux and chronic aspiration may be involved in the aetiology and sequalae of both disease states. We detail the physiological and pharmacological mechanisms involved in cough, and how the recent development of P2X3 receptor antagonists may lead to the first pharmaceutical agent licensed for chronic cough. The treatment and prevention of loss of the cough reflex, which has been largely neglected, is also discussed as novel low-cost interventions could help prevent a number of hospital and domiciliary deaths from both acute and chronic aspiration.
Citation
Sykes, D. L., & Morice, A. H. (2021). The Cough Reflex: The Janus of Respiratory Medicine. Frontiers in Physiology, 12, Article 684080. https://doi.org/10.3389/fphys.2021.684080
Journal Article Type | Review |
---|---|
Acceptance Date | Jun 9, 2021 |
Online Publication Date | Jun 29, 2021 |
Publication Date | Jun 29, 2021 |
Deposit Date | May 10, 2022 |
Publicly Available Date | May 12, 2022 |
Journal | Frontiers in Physiology |
Electronic ISSN | 1664-042X |
Publisher | Frontiers Media |
Peer Reviewed | Peer Reviewed |
Volume | 12 |
Article Number | 684080 |
DOI | https://doi.org/10.3389/fphys.2021.684080 |
Keywords | Cough; Chronic cough; Aspiration [MeSH]; Airway reflux; Reflux |
Public URL | https://hull-repository.worktribe.com/output/3813797 |
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Copyright Statement
Copyright © 2021 Sykes and Morice. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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