Table Of ContentCough:
Pathophysiology,
Diagnosis and
Treatment
Alessandro Zanasi
Giovanni A. Fontana
Donatella Mutolo
Editors
123
Cough: Pathophysiology, Diagnosis
and Treatment
Alessandro Zanasi
Giovanni A. Fontana • Donatella Mutolo
Editors
Cough: Pathophysiology,
Diagnosis and Treatment
Editors
Alessandro Zanasi Giovanni A. Fontana
Cough Study and Treatment Centre Department of Critical Care
S.I.S.Me.R. Medicine and Surgery
Bologna University of Florence
Italy Florence
Italy
Donatella Mutolo
Department of Experimental and Clinical
Medicine - Section of Physiology
University of Florence
Florence
Italy
ISBN 978-3-030-48570-2 ISBN 978-3-030-48571-9 (eBook)
https://doi.org/10.1007/978-3-030-48571-9
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Preface
Patients usually refer to the doctor complaining of a symptom but the vast majority
of medical textbooks focus on diseases rather than on symptom management.
Therefore, it follows that a symptom-oriented approach probably best reflects the
correct patient/physician interaction in all fields of clinical medicine. Symptoms
like dyspnoea, sneezing and cough are normal behavioural responses brought about
by changes in the physiological milieu of the respiratory tract. These symptoms are
not pathological conditions per se, as they may be in the case of pain; however,
when they persist and/or are troublesome, they may become intolerable and result
in severe worsening of the patient’s quality of life.
Chronic cough, that is a cough lasting longer than eight weeks, is among the
most common respiratory symptoms for which patients seek medical advice. It has
long been recognised that virtually all diseases of the respiratory tract, and some
non-respiratory disorders, are accompanied by chronic cough, and that a relevant
percentage of individuals may suffer from a long-lasting cough for which no respi-
ratory or extra-respiratory cause can be identified. While in the first instance treat-
ment of the underlying cause almost invariably results in cough disappearance, in
the case of a cough of unknown origin, management often fails, and patients are left
with a chronic condition severely affecting their everyday life. These patients are
currently believed to be affected by a condition known as the “cough hypersensitiv-
ity syndrome” (CHS), in which the physiological cough reflex becomes hypersensi-
tised to stimuli that are innocuous to the normal population. The hypersensitisation
mechanisms are still poorly defined and may implicate both peripheral and central
(medullary) neural structures that are crucial for the production of the cough motor
pattern and potentially represent a strategic site of action for antitussive drugs. One
of the main reasons for treatment failure in patients with CHS is that doctors do not
try to suppress a fundamental defensive reflex mechanism, thus causing obvious
detrimental effects. Rather, they try to control the excess coughing while maintain-
ing a normally functioning defensive response. This attempt has been the object of
recent physiological, pathophysiological and pharmacological research, the most
significant advancements of which are dealt with in this book. Indeed, investiga-
tions on the basic physiological and pathophysiological mechanisms underlying
cough could lead to novel therapeutic approaches.
This book also provides an updated and comprehensive overview of the new
perspectives for clinical management of patients with chronic cough. It enables
vii
viii Preface
readers to gain an in-depth understanding of the diagnostic workup of cough, still
one of the most frequent and challenging symptoms in daily medical practice. The
most common causes of chronic cough (asthma, postnasal drip, gastro-oesophageal
reflux and chronic hypersensitivity syndrome) are also explored as well as the dif-
ferent types of paediatric cough.
Bologna, Italy Alessandro Zanasi
Florence, Italy Giovanni A. Fontana
Florence, Italy Donatella Mutolo
Contents
Part I C ough Sensorymotor Mechanisms
1 Physiology of the Cough Reflex: Sensory
and Mechanical Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Donatella Mutolo, Ludovica Iovino, Elenia Cinelli,
Fulvia Bongianni, and Tito Pantaleo
2 Sensory Pathways and Neural Modulation of Cough . . . . . . . . . . . . . . 23
Ivan Poliacek
3 Brainstem Structures Involved in the Generation
of Reflex Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Donatella Mutolo, Ludovica Iovino, Elenia Cinelli,
Fulvia Bongianni, and Tito Pantaleo
4 The Cough Motor Pattern . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Ivan Poliacek
Part II C linical Assessment of Cough
5 Acute and Chronic Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Giovanni A. Fontana
6 Chronic Cough and Upper Airway Syndrome . . . . . . . . . . . . . . . . . . . . 95
Giovanni A. Fontana, Guja Bernacchi, and Alessio Fabbrizzi
7 Chronic Cough During Bronchial Asthma . . . . . . . . . . . . . . . . . . . . . . . 103
Giovanni A. Fontana, Guja Bernacchi, and Alessio Fabbrizzi
8 Chronic Cough During Gastro- oesophageal Reflux . . . . . . . . . . . . . . . 115
Giovanni A. Fontana, Guja Bernacchi, and Alessio Fabbrizzi
9 Clinical Methods for the Study of Cough . . . . . . . . . . . . . . . . . . . . . . . . 127
Federico Lavorini, Guja Bernacchi, and Alessio Fabbrizzi
ix
x Contents
10 Diagnostic Approach in Adult Patients with Chronic Cough . . . . . . . . 137
Giovanni A. Fontana, Guja Bernacchi, and Alessio Fabbrizzi
11 Age-Related Remodeling in Cough: What May Stand Behind . . . . . . . 141
Ahmad Kantar
Part III Cough Therapy
12 Pharmacological Therapy of Acute and Chronic Cough. . . . . . . . . . . . 157
A. Zanasi, M. Mazzolini, and U. Caliceti
13 Emerging Drugs for Chronic Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Federico Lavorini, Guja Bernacchi, and Alessio Fabbrizzi
Part I
Cough Sensorymotor Mechanisms
