\n
Interview Summary<\/h3>\n
Chronic cough is common and often debilitating in patients with idiopathic pulmonary fibrosis (IPF), affecting most people living with the condition. It is typically persistent and difficult to control, and can cause significant physical consequences, including pain, sleep disruption, and fatigue. In severe cases, it can cause vomiting and even rib fractures. Beyond the physical burden, chronic cough has a profound psychosocial impact, contributing to embarrassment, social withdrawal, and reduced quality of life. Despite this, it is frequently overlooked in clinical care. Limited effective treatment options mean it is often deprioritised in favour of more measurable aspects of disease, leaving many patients without adequate support or relief.<\/span><\/p>\nHowever, growing scientific understanding is beginning to change this landscape. Chronic cough is increasingly recognised not simply\u00a0as a\u00a0consequence\u00a0of\u00a0lung disease, but as a neuropathic condition involving dysregulation of peripheral and central nervous system\u00a0(CNS)\u00a0pathways. This shift in thinking is helping to\u00a0identify\u00a0new therapeutic targets and is driving the development of\u00a0potentially\u00a0more effective treatments. As a result, the future of care in IPF may look\u00a0very different, with the\u00a0possibility of personalised medicine, multidisciplinary care, and\u00a0a greater emphasis on recognising and managing\u00a0the\u00a0full impact\u00a0of chronic cough\u00a0on patients\u2019 lives.<\/span><\/p>\nThis work will discuss the burden and mechanisms of chronic cough, as well as the future of IPF care, with two leading experts in the field and an Ohio grandfather, whose chronic cough forced him to retire from a job he loved.<\/span><\/p>\n<\/div>\n\n
INTRODUCTION<\/h2>\n
IPF\u00a0is a form of interstitial lung disease.1<\/sup> It\u00a0is\u00a0a\u00a0chronic, progressive lung disease\u00a0that affects around 3\u00a0million\u00a0people worldwide, and\u00a0is\u00a0more\u00a0prevalent in those over the age of\u00a050\u00a0years.1,2<\/sup>\u00a0It is characterised by progressive\u00a0scarring\u00a0of the lungs\u00a0and\u00a0is often associated with\u00a0cough, dyspnoea, and reduced quality of life.1<\/sup>\u00a0Chronic cough, defined\u00a0as a\u00a0cough\u00a0that\u00a0lasts for\u00a0more than\u00a08\u00a0weeks,\u00a0is\u00a0common\u00a0in\u00a0IPF.2,3<\/sup>\u00a0Affecting up to 85% of people living with the condition,\u00a0cough\u00a0can\u00a0develop prior to a diagnosis\u00a0of IPF\u00a0and\u00a0is often the\u00a0initial\u00a0reason\u00a0people\u00a0seek help from their doctor.3-5<\/sup>\u00a0\u201cMany of our patients report it as a dry, or non-productive, cough that is persistent throughout the day. Some, however, especially those who are former smokers or\u00a0have\u00a0concurrent airway disease,\u00a0report a cough that can be productive of some clear sputum,\u201d\u00a0said Tejaswini Kulkarni,\u00a0Associate\u00a0Professor of\u00a0Medicine, Director of the Interstitial Lung Disease Program,\u00a0and Associate Medical\u00a0Director\u00a0of the\u00a0Lung Health Center, The University of Alabama at Birmingham, USA.<\/p>\nPatients often describe\u00a0cough\u00a0as the most burdensome\u00a0aspect\u00a0of\u00a0their\u00a0IPF, and it has a wide-ranging impact.6<\/sup> It can\u00a0cause\u00a0chest\u00a0pain, light-headedness,\u00a0syncope, sleep disturbance, vomiting,\u00a0and even rib fractures. Patients\u00a0also\u00a0report\u00a0embarrassment, and\u00a0social\u00a0and professional\u00a0isolation.3<\/sup> \u201cIt is incredibly debilitating for people,\u201d said\u00a0Matthew Drake,\u00a0Head of the\u00a0Division of\u00a0Pulmonary,\u00a0Allergy,\u00a0and\u00a0Critical\u00a0Care; and the\u00a0Edwards\u00a0Professor of Pulmonary Medicine at\u00a0the\u00a0Oregon Health\u00a0and\u00a0Science University, Portland, USA.\u00a0\u201cThis constant urge to cough throughout your day will prevent you from doing things like speaking\u00a0in front of others, because you realise you\u00a0are going to cough the minute you start to vocalise words.\u201d This is something\u00a0Steve Ashton knows\u00a0only too\u00a0well. The\u00a0grandfather of four and former police officer\u00a0felt\u00a0forced to abandon his\u00a0second\u00a0career as an accident reconstructionist\u00a0due to chronic cough. \u201cI used to\u00a0teach and\u00a0give presentations. But when you are at the podium and you\u00a0just start coughing,\u00a0it\u00a0is humiliating,\u201d\u00a0he explained.<\/p>\nDespite the\u00a0impact chronic cough can have on physical and mental health, treatment options are limited.3,5,7<\/sup>\u00a0There are no approved therapies to specifically target IPF cough;\u00a0approved IPF medications, such as antifibrotics, have not been evaluated for cough.5<\/sup>\u00a0Standard\u00a0antitussives, including over-the-counter\u00a0cough drops,\u00a0neuromodulators, gabapentin, and pregabalin,\u00a0and\u00a0non-pharmacological approaches,\u00a0including\u00a0speech therapy or physiotherapy, are often ineffective.5,7<\/sup>\u00a0In many cases,\u00a0Kulkarni said, this had led\u00a0to healthcare professionals simply not talking to patients about\u00a0cough\u00a0and its impact.<\/p>\nIn recent years,\u00a0however,\u00a0advances in research have started to open a window\u00a0to\u00a0the mechanisms of chronic cough.2<\/sup>\u00a0With this deeper understanding comes the\u00a0potential for a new treatment landscape\u00a0that may help to tackle this\u00a0significant unmet need in IPF care, Kulkarni and Drake believe.<\/p>\nMECHANISM OF CHRONIC COUGH<\/h2>\n
Chronic cough is the\u00a0most\u00a0predominant\u00a0and, in many cases,\u00a0most\u00a0burdensome part of living with\u00a0IPF,\u00a0said Drake.2,6<\/sup> \u201cFor some, it\u00a0may be even\u00a0more troubling than shortness\u00a0of breath,\u00a0because it is so persistent,\u201d\u00a0he added.\u00a0In recent years, there\u00a0has\u00a0been a\u00a0\u201cseismic shift\u201d in\u00a0the scientific\u00a0understanding of chronic cough.\u00a0\u201cWe have recognised that\u00a0it\u00a0is\u00a0not just a pulmonary problem: it\u00a0is a consequence of dysfunction between the peripheral nerves in the\u00a0airways\u00a0and their connections\u00a0to the\u00a0brainstem,\u201d he said.\u00a0In essence, it\u00a0is a neuropathic problem that involves peripheral airway triggers,\u00a0as well as\u00a0how\u00a0signals are sensed and responded to centrally, he went on.7-9<\/sup><\/p>\nA cough happens when\u00a0sensory nerves in the airways are activated by stimuli and send\u00a0a signal\u00a0to the CNS. This, in turn, triggers an alteration in the respiratory pattern to produce a cough.\u00a0This\u00a0reflexive\u00a0pathway is intended to protect the lungs from foreign\u00a0materials, and, in\u00a0general, the stronger the stimuli, the\u00a0stronger the urge to cough.7<\/sup>\u00a0\u201cUnlike acute cough, which is protective, chronic cough is maladaptive,\u201d said Drake, adding that\u00a0chronic cough is\u00a0caused by increased and amplified signals between the peripheral\u00a0nervous system (PNS) and the CNS.7-9<\/sup>\u00a0\u201cThe\u00a0sensory nerves in\u00a0the\u00a0airways,\u00a0those that travel up to our brain and trigger things like reflexive cough when we choke or aspirate something,\u00a0are\u00a0really central\u00a0to chronic cough.\u201d2,9<\/sup>\u00a0When these\u00a0pathways become dysfunctional,\u00a0it\u00a0heightens their\u00a0response to both noxious and innocuous stimuli\u00a0and\u00a0lowers the\u00a0CNS\u2019s\u00a0threshold for triggering cough,\u00a0thereby\u00a0leading to cough hypersensitivity, he explained.9<\/sup> \u201cPatients\u00a0who\u00a0experience\u00a0chronic cough\u00a0describe having an urge to cough,\u00a0or an actual production of a cough,\u00a0in relation to innocuous stimuli:\u00a0things like breathing cold air,\u00a0laughing,\u00a0or talking,\u00a0will trigger a cough.\u00a0This\u00a0constant tickle in\u00a0the\u00a0throat, that urge to cough,\u00a0is\u00a0at the cornerstone of cough hypersensitivity. Mechanistically, we think this is\u00a0due\u00a0to\u00a0changes in the threshold for nerve activation\u00a0and successive nerve triggering.\u201d9<\/sup><\/p>\nExpanding on this, Drake explained that, historically,\u00a0airway\u00a0sensory\u00a0nerves\u00a0have been classified as either\u00a0nociceptors, those that\u00a0respond to\u00a0chemical signals,\u00a0or\u00a0mechanoreceptors,\u00a0those that\u00a0respond to\u00a0physical deformation, pressure, or movement of the airways.10<\/sup>\u00a0Advanced\u00a0research techniques,\u00a0such as single-cell genomics,\u00a0however,\u00a0have\u00a0provided a deeper understanding of this complex network\u00a0and\u00a0revealed a\u00a0variety of subtypes\u00a0within\u00a0those two main classifications.10<\/sup>\u00a0\u201cNot only has it shown us that we have this incredibly rich diversity of sensory nerves in the airways, but it\u00a0has also\u00a0allowed\u00a0us\u00a0to trace those connections to where they integrate\u00a0with\u00a0the brainstem, and understand\u00a0how the brainstem interfaces with higher cortical neurones.\u00a0In essence, it\u00a0has given us a tremendous amount of information about how this system functions, both in health and how it begins to change and evolve in disease.\u201d10<\/sup><\/p>\nSuch work has uncovered a range of receptors and ion channels that\u00a0contribute to\u00a0chronic cough.10<\/sup>\u00a0At the\u00a0peripheral\u00a0level,\u00a0adenosine triphosphate, for example, which is released by injured or activated airway epithelial cells, acts on the\u00a0nerve fibres through purinergic receptors,\u00a0such as\u00a0purinergic receptor P2X 3\u00a0(P2X3),\u00a0that\u00a0stimulate the cough reflex.10,11<\/sup>\u00a0Transient receptor potential channels, which\u00a0have been identified in\u00a0airway sensory neurones, airway epithelial cells, and airway smooth muscle cells\u00a0mediate chemosensitivity to various endogenous and exogenous triggers.12,13<\/sup>\u00a0In addition, some subtypes of\u00a0voltage-gated sodium channels, which are\u00a0essential\u00a0for\u00a0the\u00a0action potential\u00a0in response\u00a0to\u00a0all stimuli, are\u00a0predominantly\u00a0expressed in cough-triggering airway nerves.14<\/sup>\u00a0Drake also explained that\u00a0opioid receptors, such as\u00a0kappa and mu,\u00a0play a pivotal role in both the peripheral and central\u00a0neural pathways involved in cough. These\u00a0can be found in high numbers in\u00a0the CNS and PNS regions that regulate sensitisation.7<\/sup><\/p>\nIn turn, these discoveries have identified\u00a0new treatment targets, and the\u00a0therapeutic landscape is evolving rapidly.2,10<\/sup>\u00a0Drake\u00a0highlighted a\u00a0dual opioid agonist\/antagonist approach,\u00a0which\u00a0modulates\u00a0both central and peripheral neurotransmission involved in cough, via kappa opioid receptor agonism, while limiting side effects, such as respiratory depression and abuse liability, via mu opioid receptor antagonism.7<\/sup>\u00a0\u201cHere, the goal\u00a0is\u00a0not just stopping\u00a0the\u00a0triggering at the source in the airway, but\u00a0also\u00a0turning down the volume\u00a0in\u00a0the brainstem and cortex to address that key underlying problem of cough\u00a0hypersensitivity,\u201d\u00a0he said.<\/p>\nWhat is currently unclear\u00a0is\u00a0why this\u00a0CNS\/PNS dysfunction develops, said Drake.\u00a0\u201cWe know that the sensory nerves in the airway grow and increase in their overall density, and we know that they become excessively prone to firing and sending those signals to the brainstem.\u00a0We also know\u00a0that changes in\u00a0brainstem and cortical centres\u00a0occur\u00a0because\u00a0of excessive firing, and that\u00a0leads to\u00a0this\u00a0heightened activity level,\u201d he explained.10<\/sup>\u00a0Why certain people develop\u00a0these changes\u00a0while\u00a0others do\u00a0not, however,\u00a0\u201cis\u00a0not\u00a0totally clear.\u201d\u00a0It may be that some people are born with more\u00a0nerves, or with differences in the nervous system connections,\u00a0making them more\u00a0susceptible,\u00a0he said.15<\/sup> In IPF, Drake went on,\u00a0it is\u00a0possible that the fibrotic\u00a0processes in the lungs\u00a0contribute to excessive cough triggering.16<\/sup>\u00a0There is also a suspicion that\u00a0fibrosis\u00a0promotes\u00a0a feedback loop in which the more a person coughs, the more\u00a0impact it has on the peripheral nerves in the airways, thereby\u00a0amplifying peripheral responses.17<\/sup>\u00a0\u201cThe consequence is\u00a0that\u00a0the brain is going to modulate the way it processes\u00a0the signals\u00a0centrally,\u00a0to try to accommodate\u00a0the\u00a0excessive peripheral cough triggering.\u201d\u00a0Such a combination, he\u00a0went on,\u00a0may\u00a0have a maladaptive\u00a0effect, leading to cough hypersensitivity and progressively worsening chronic cough triggering.16,17<\/sup><\/p>\nCARING FOR A PATIENT WITH CHRONIC COUGH AND IPF<\/h2>\n
Regardless of the underlying mechanisms, chronic cough has\u00a0a huge impact\u00a0on the lives of people living with IPF.3,6<\/sup><\/p>\nKulkarni said\u00a0the majority of\u00a0the patients she saw in\u00a0the\u00a0clinic experience it. \u201cIt is not just a cough that might go away. This is\u00a0something the patient\u00a0has to\u00a0live with. It\u00a0can cause fatigue\u00a0and\u00a0disrupt sleep. When it\u00a0is severe, it can cause chest discomfort or even incontinence in some.\u201d3,6<\/sup>\u00a0The\u00a0negative effects, she went on, often go beyond the physical. \u201cThe psychological and social impact is very significant and often\u00a0overlooked,\u201d3<\/sup>\u00a0she explained.\u00a0People can be\u00a0embarrassed,\u00a0avoid social situations, and, in some cases,\u00a0develop anxiety and depression.3,6<\/sup>\u00a0Such feelings were compounded during the COVID-19 pandemic, when coughing in public became a visible sign of infection, she explained.\u00a0\u201cA\u00a0lot of patients tell us that cough probably impacts\u00a0their quality of life more\u00a0than shortness of breath.\u201d<\/p>\nHighlighting the burden, Kulkarni pointed to a\u00a0survey of\u00a0197 people with\u00a0IPF\u00a0and non-IPF\u00a0interstitial lung disease\u00a0who experienced\u00a0chronic cough.18<\/sup>\u00a0A total of\u00a063%\u00a0reported\u00a0they\u00a0\u201coften\u201d\u00a0or\u00a0\u201calmost constantly\u201d had the\u00a0urge to cough, while only 4% said coughing\u00a0always\u00a0relieved that\u00a0urge.\u00a0The most common triggers were respiratory\u00a0related\/sensation (22%) and exertion\/physical activity\/body position (22%), while 15%\u00a0reported unknown\u00a0triggers,\u00a0and the\u00a0cough\u00a0was\u00a0unpredictable. Normal everyday events such as talking or laughing (7%) or eating and drinking (7%) were also identified as triggers. Almost 80%\u00a0reported\u00a0that, once they started coughing,\u00a0they\u00a0continued\u00a0coughing\u00a0for more than 30 seconds.\u00a0In terms of frequency, 35% reported\u00a0daily coughing bouts, while around 30%\u00a0reported coughing\u00a0four or more times a week.18<\/sup><\/p>\nThe\u00a0survey\u00a0also\u00a0demonstrated\u00a0the significant\u00a0impact\u00a0cough\u00a0had on their lives.18<\/sup>\u00a0Almost half\u00a0(48%)\u00a0of patients\u00a0reported\u00a0that\u00a0their cough interfered with\u00a0activities of daily living\u00a0\u201csometimes,\u201d\u00a0\u201coften,\u201d\u00a0or\u00a0\u201cdaily,\u201d while\u00a046%\u00a0experienced\u00a0fatigue or exhaustion as a result of their cough. In 45% of respondents,\u00a0cough\u00a0\u201csometimes,\u201d \u201coften,\u201d\u00a0or \u201calways\u201d\u00a0caused\u00a0them\u00a0to\u00a0avoid social situations, while\u00a016%\u00a0said\u00a0it had significantly or extremely affected their\u00a0ability to\u00a0maintain\u00a0physical or intimate relationships.\u00a0When asked about the emotional impact of chronic cough, 71% reported\u00a0feeling\u00a0frustrated, 59% embarrassment, and almost a third (32%) anxiety.18<\/sup>\u00a0The data show, said Kulkarni, that chronic cough in IPF is \u201cnot minor.\u201d \u201cIt\u00a0has\u00a0a\u00a0profound impact on quality of life,\u201d she noted.<\/p>\nParticipants\u2019 experience of healthcare with\u00a0regard\u00a0to their chronic cough\u00a0was also explored\u00a0in the survey.18<\/sup>\u00a0The unmet need was clear\u00a0in the findings.\u00a0Of the 171 people who answered the question,\u00a056% said they were\u00a0currently\u00a0using over-the-counter remedies,\u00a0and 53%\u00a0reported using inhalers or nebulisers. Other common\u00a0treatments included benzonatate\u00a0(22%), proton pump inhibitors\u00a0(21%), and glucocorticoids\u00a0(21%), while 11%\u00a0reported\u00a0no treatments\u00a0and 2%\u00a0reported speech or cough therapy. Yet\u00a063% of\u00a0participants\u00a0said they had experienced\u00a0no\u00a0relief,\u00a0or only\u00a0partial\/somewhat relief,\u00a0with current or previous treatments.\u00a0In addition,\u00a0only\u00a050% of participants\u00a0said they felt \u201cheavily involved in decisions about their cough treatment and care.\u201d18<\/sup><\/p>\nKulkarni said it was \u201creally important\u201d to routinely\u00a0assess\u00a0and\u00a0proactively\u00a0address cough,\u00a0and to\u00a0involve patients in the decision-making\u00a0process.\u00a0\u201cWe are challenged by the fact that we do\u00a0not have many therapeutic options.\u00a0Because of that, the amount of time spent talking to patients about cough\u00a0is limited,\u201d3,5,7<\/sup>\u00a0she said, adding that\u00a0healthcare providers tended\u00a0to focus more on objective data, such as lung function,\u00a0CT scans, and walk tests, simply because they\u00a0were measurable.\u00a0Another challenge is a lack of\u00a0assessment\u00a0tools. In the research setting, patient-reported measures such as the Leicester Cough\u00a0Questionnaire\u00a0(LCQ) and the\u00a0Cough\u00a0Visual\u00a0Analogue\u00a0Score (VAS)\u00a0are\u00a0often\u00a0used to quantify severity.19,20<\/sup>\u00a0Objective cough monitoring, which\u00a0utilises\u00a0wearable technology to measure cough frequency and intensity, is\u00a0also\u00a0common\u00a0in trials.21<\/sup>\u00a0There are several factors, however, that limit the use of such tools in routine clinical practice.\u00a0Multi-item,\u00a0structured\u00a0questionnaire tools, for example,\u00a0are\u00a0often\u00a0not practical from a time\u00a0standpoint,\u00a0and\u00a0monitors are not\u00a0validated\u00a0for use in the clinic, Kulkarni explained.22,23<\/sup><\/p>\nExplaining her own\u00a0assessment and management\u00a0method, Kulkarni said she used a stepwise approach.\u00a0Assessment starts with taking a detailed history, looking at factors such as the duration of cough,\u00a0the diurnal variations, and triggers.\u00a0She\u00a0attempts\u00a0to\u00a0identify\u00a0any common contributors, such as gastro-oesophageal reflux, upper airway conditions, or medications.5<\/sup>\u00a0She can then suggest treating the underlying cause.\u00a0\u201cIf a patient\u00a0says their\u00a0cough is\u00a0worse after they eat or lay down flat,\u00a0for example,\u00a0the cause\u00a0may\u00a0be reflux, rather than the IPF itself.\u201d\u00a0Potential\u00a0interventions include\u00a0cough\u00a0drops or over-the-counter cough medicines,\u00a0and benzonatate, which reduces the cough reflex. However, efficacy is\u00a0limited. Low-dose opioids\u00a0are\u00a0an option\u00a0that\u00a0may help some patients;\u00a0however,\u00a0they\u00a0\u201ccome with\u00a0[their]\u00a0own challenges,\u201d said\u00a0Kulkarni.\u00a0\u201cWe have to be mindful of the potential side effects.\u201d5<\/sup><\/p>\nDespite the challenges\u00a0and the limited treatment options,\u00a0there is\u00a0still\u00a0much to gain from having a conversation about cough in\u00a0the\u00a0clinic. Reflecting on her own experience,\u00a0Kulkarni explained:\u00a0\u201cEven if you cannot eliminate the cough completely, improving it just slightly can have a meaningful difference to the patient\u2019s life,\u201d\u00a0she said.\u00a0Upcoming and ongoing clinical trials may be\u00a0an option\u00a0for some\u00a0people, and,\u00a0even where there are no suitable interventions, just having the conversation can\u00a0help\u00a0make the person feel validated. \u201cAt least they know that I have thought about it and am not ignoring\u00a0it.\u00a0Just that can have a psychological impact,\u201d\u00a0she added.<\/p>\n
LIVING WITH CHRONIC COUGH: A PATIENT PERSPECTIVE<\/h2>\n
Steve\u00a0Ashton, a motorbike\u00a0enthusiast\u00a0and grandfather\u00a0living in\u00a0Cincinnati, Ohio,\u00a0USA,\u00a0knows\u00a0the impact of living with\u00a0a\u00a0chronic cough\u00a0only too\u00a0well.\u00a0It had such\u00a0a huge impact\u00a0on his ability to\u00a0speak that he gave up his business, and\u00a0he\u00a0routinely\u00a0chooses to avoid\u00a0social gatherings.\u00a0\u201cI have absolutely no control over the cough,\u201d he said. \u201cWhen it comes, it comes, and I just\u00a0have to\u00a0bear with it until it is over. Sometimes it gets to the point where I physically get muscle aches in my back and shoulders, just from the cough itself.\u201d<\/p>\n
Like many people living with\u00a0the condition, he experienced\u00a0a\u00a0cough\u00a0long before his\u00a0IPF\u00a0diagnosis, which came in 2021. He said he did not think much of it at first, but it got progressively worse over the course\u00a0of\u00a05\u201310 years.\u00a0\u201cThere is a joke in\u00a0the\u00a0Cincinnati area that if you do\u00a0not have a sinus infection, you are definitely not from Ohio,\u201d he said. \u201cAll my life,\u00a0I have\u00a0had coughs, and they\u00a0have been treated as sinus infections.\u201d\u00a0When he was finally diagnosed\u00a0with IPF, he realised\u00a0that he had been coughing for some time and that\u00a0he had the same condition that had led to the death of both his mother and his youngest brother.<\/p>\n
While he and Lucie, his wife of 48 years, are\u00a0very active, regularly enjoying camping, hiking, and cycling,\u00a0a\u00a0chronic cough has had\u00a0a huge impact\u00a0on his life.\u00a0After retiring from a 28-year law enforcement career\u00a0in\u00a02008,\u00a0he\u00a0was running an independent accident reconstruction franchise,\u00a0which\u00a0frequently\u00a0involved giving talks and presentations,\u00a0when he received his diagnosis. However,\u00a0his cough forced him to\u00a0retire\u00a0at the end of 2024.\u00a0\u201cIt was humiliating to stand at the podium\u00a0in full uniform,\u00a0trying\u00a0to\u00a0talk to 300\u00a0or 400 police officers, and just start coughing in the middle of it.\u00a0I am a very professional person,\u00a0and it\u00a0pulled away\u00a0at\u00a0my pride,\u201d Ashton explained. \u201cIt got to a point where I\u00a0was so\u00a0embarrassed, I thought\u00a0\u2018I just cannot\u00a0do this anymore\u2019.\u00a0I loved\u00a0what I\u00a0was\u00a0doing, but my\u00a0personal\u00a0perception\u00a0was that\u00a0people thought\u00a0less of\u00a0me.\u201d\u00a0Describing the feeling, he said:\u00a0\u201cPicture yourself during the COVID era, when you go into\u00a0a\u00a0store, and everybody is wearing masks. The first person who coughs, everyone thinks \u2018Oh my God, we have to get away from you\u2019.\u201d\u00a0This embarrassment, as well as cough-related fatigue,\u00a0has also\u00a0significantly\u00a0impacted\u00a0his social life. \u201cI feel like I have isolated myself,\u201d said Ashton. \u201cI do not have the drive to\u00a0go\u00a0to\u00a0see people,\u00a0because I feel like I am becoming a zombie. I cannot function,\u00a0and it is humiliating.\u201d<\/p>\n
Despite the\u00a0huge impact\u00a0chronic cough has had on his life, Ashton said\u00a0his healthcare team had never addressed the\u00a0cough\u00a0with him. \u201cI would mention it\u00a0to\u00a0my pulmonologist,\u00a0but\u00a0it was like the cough was just a sidebar,\u201d he said.\u00a0\u201cI\u00a0started to\u00a0wonder,\u00a0\u2018Did I really say that, or did I just think I said it?\u2019\u00a0It was like it went in one ear and out the other.\u201d\u00a0Through patient forums, he has found an over-the-counter cough drop\u00a0which he\u00a0said,\u00a0\u201chelps a little,\u201d\u00a0but\u00a0\u201conly sometimes.\u201d\u00a0\u201cI\u00a0will take those when I\u2019m driving or when it gets to the point where I can\u2019t have a conversation\u2026 but there really is nothing else I have found that can control it.\u201d\u00a0He described the cough drop, as well as\u00a0drinking mullein tea, as \u201cvery, very short stopgaps\u201d that \u201cdo not address the issue behind\u201d his chronic cough.\u00a0\u201cI wish there was something the medical field could do to prepare us\u00a0for\u00a0the way life is going to be.\u201d<\/p>\n
In terms of triggers, he said there seemed to be \u201cno rhyme or reason for it.\u201d \u201cIt just comes and goes on its own,\u201d he went on, adding that each coughing fit could last for anything from 60 seconds to\u00a03\u00a0minutes.\u00a0\u201cIt just comes on like a regular cough, but it physically hurts\u00a0more\u00a0than a normal cough, and\u00a0I can hear the wheezing when I cough\u00a0dramatically.\u201d Asked\u00a0what he\u00a0would like to\u00a0change about\u00a0his cough, he said he\u00a0wished\u00a0it would go away.\u00a0\u201cIf there was some way of managing it, it would give me a piece of my life back. I would love to get back out in public and enjoy life.\u201d Even reducing the cough\u00a0by 10%, he added, \u201cwould be better than nothing.\u201d<\/p>\n
FUTURE OF CHRONIC COUGH MANAGEMENT<\/h2>\n
Ashton\u2019s story\u00a0may sound\u00a0very\u00a0familiar to\u00a0pulmonologists who work with people living with IPF.\u00a0The future, however, could look\u00a0very different, said Drake. \u201cOne of the biggest shifts\u00a0in the field of chronic cough\u00a0recently\u00a0is\u00a0really conceptual. It says\u00a0that\u00a0chronic cough is\u00a0not just a symptom of other diseases,\u00a0but\u00a0a neuropathic disorder:\u00a0changes in the nervous system that regulate cough lead to a persistent and chronic disease that is incredibly debilitating,\u201d he explained.7-9<\/sup> \u201cThis reframing\u00a0is\u00a0important\u00a0scientifically in terms of\u00a0how we\u00a0are thinking about developing new therapeutic strategies, but it\u00a0is also going to be fundamentally important for the way we address\u00a0chronic cough\u00a0clinically.\u201d<\/p>\nAs the evidence base deepens, and new agents make their way through pipelines and out into clinical practice,\u00a0there is a potential for\u00a0personalised treatments, he went on.\u00a0\u201cI\u00a0am hopeful for a day when\u00a0we have multiple options in this space, and\u00a0that we\u00a0will\u00a0be able to do things like phenotype various forms of cough in a\u00a0really precise\u00a0way.\u00a0Then we would be able to\u00a0treat patients in a really targeted\u00a0way,\u00a0based on biomarkers or other clinical features.\u201d\u00a0Kulkarni agreed. \u201cAs we develop a deeper understanding of the mechanisms of chronic cough, IPF, and its impact on patient outcome, I hope to see a shift towards more targeted, personalised\u00a0treatments,\u201d she said. \u201cThis may be\u00a0the\u00a0treatment of comorbidities,\u00a0or specific treatment\u00a0[for]\u00a0cough,\u00a0or its direct impact.\u201d She hopes a new generation of chronic cough treatments would \u201ctruly have an impact on cough while minimising the side effects seen with the currently available options.\u201d5<\/sup>\u00a0Drake said the scientific community was\u00a0currently\u00a0in the process of\u00a0\u201cmoving down this really transformative pathway.\u201d \u201cIt is a very\u00a0exciting time to be in the field, and I think we\u00a0are going to be looking at this in a very different way in\u00a05\u00a0or\u00a010\u00a0years\u2019 time,\u201d he added.<\/p>\nAs the research continues to develop, Kulkarni said she would like to see better tools for measuring cough make their way into clinical practice\u00a0and for IPF care to\u00a0move towards a\u00a0multidisciplinary approach\u00a0that places more emphasis on the patient\u2019s perspective.\u00a0\u201cI\u00a0hope\u00a0we will learn more about speech therapy and involve that in our multidisciplinary approach, and maybe even getting\u00a0[the]\u00a0palliative care team involved earlier to help with the symptoms.\u201d\u00a0Without this\u00a0holistic approach, there is a danger of\u00a0overreliance\u00a0on objective data\u00a0such as forced vital capacity, which does not necessarily reflect how the person feels\u00a0or how the condition is\u00a0impacting\u00a0their lives, she\u00a0believes.\u00a0\u201cWe are just making the numbers look good, without truly having a holistic impact on how the patient feels.\u00a0Trying to get this\u00a0multidisciplinary approach, combined with,\u00a0hopefully,\u00a0better treatment options in the future,\u00a0could\u00a0really help us change that.\u201d<\/p>\n
CONCLUSION<\/h2>\n
Summing up, Kulkarni said that chronic cough in IPF is far more than an\u00a0inconvenient symptom.\u00a0It\u00a0profoundly\u00a0affects\u00a0patients\u2019 physical, emotional, and social wellbeing, and\u00a0frequently overshadows breathlessness in terms of day-to-day burden.2,5,6,19<\/sup>\u00a0Ashton\u2019s\u00a0personal\u00a0experience of living with\u00a0chronic cough\u00a0clearly illustrates how\u00a0it\u00a0can erode confidence, limit professional and social participation, and lead to isolation, anxiety, and reduced quality of life.<\/p>\nDespite this, chronic cough has historically been under-recognised and insufficiently addressed in clinical practice.3<\/sup>\u00a0Limited treatment options coupled with inconsistent assessment and a tendency to prioritise objective disease markers\u00a0have contributed to a gap in care.3,19,20<\/sup>\u00a0However, recent advances in understanding the underlying mechanisms,\u00a0particularly the recognition of chronic cough as a neuropathic disorder involving dysregulated peripheral and central neural pathways, mark an important turning point.8-10<\/sup><\/p>\nUltimately, understanding the mechanisms and the burden of\u00a0chronic cough matters, said Drake.<\/p>\n
\u201cThe fact is that,\u00a0in the clinic, chronic cough is a very, very prevalent concern. Patients suffer with this for months and years, and we have few to no effective therapeutics for targeting this incredibly debilitating disease.\u201d It prevents patients from being social,\u00a0from\u00a0working,\u00a0and from living their lives in the way they want, he said.<\/p>\n
Now, that could all be about to change. \u201cWe\u00a0are potentially on the cusp\u00a0of new therapies.<\/p>\n
There\u00a0is\u00a0a lot of enthusiasm about those that are coming through the pipeline,\u00a0and\u00a0that we\u00a0might\u00a0finally be able to offer something\u00a0to\u00a0the millions of\u00a0patients who have really been suffering.\u201d<\/p>\n<\/div>\n
\n
Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Support: The publication of this article was funded by Trevi Therapeutics. Interviewees: Tejaswini Kulkarni,1 Matthew Drake,2 Steve Ashton3 1. The University of Alabama at Birmingham, USA2. Oregon Health and Science…<\/p>\n","protected":false},"author":1,"featured_media":181155,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[7],"tags":[],"class_list":["post-181154","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-national-news"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/newslink360.space\/wp-content\/uploads\/2026\/06\/KOL-article-Resp-Burden-and-Mechanism-of-Chronic-Cough-in-People-Living-with-Idiopathic-Pulmonary-Fi.jpeg","jetpack_likes_enabled":true,"jetpack-related-posts":[{"id":178097,"url":"https:\/\/newslink360.space\/?p=178097","url_meta":{"origin":181154,"position":0},"title":"Israel-Iran War Live: Iran says Strait of Hormuz will stay open but ships may face transit fees – India Today","author":"Ajay Kumar Verma","date":"June 8, 2026","format":false,"excerpt":"Israel-Iran War Live: Iran says Strait of Hormuz will stay open but ships may face transit fees\u00a0\u00a0India TodayIran\u2019s top negotiator threatens U.S. targets over Lebanon escalation\u00a0\u00a0The HinduIsrael strikes Beirut despite truce, Iranian lawmker threatens to retaliate\u00a0\u00a0ThePrintIran Threatens US Interests, Israel After Beirut Strike\u00a0\u00a0Deccan Chronicle'Leave Iran': India Issues Advisory After Renewed\u2026","rel":"","context":"In "National News"","block_context":{"text":"National News","link":"https:\/\/newslink360.space\/?cat=7"},"img":{"alt_text":"","src":"https:\/\/i0.wp.com\/newslink360.space\/wp-content\/uploads\/2026\/05\/J6_coFbogxhRI9iM864NL_liGXvsQp2AupsKei7z0cNNfDvGUmWUy20nuUhkREQyrpY4bEeIBucs0-w300-rw.webp?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":178004,"url":"https:\/\/newslink360.space\/?p=178004","url_meta":{"origin":181154,"position":1},"title":"IND vs AFG: Manav Suthar picks wicket in first over on Test debut, joins rare club of Indians","author":"Ajay Kumar Verma","date":"June 7, 2026","format":false,"excerpt":"Debutant spinner Manav Suthar became only the eighth Indian to pick a wicket in his first over in Tests when he claimed the scalp of Afghanistan opener Abdul Malik during the one-off Test between the two sides in New Chandigarh on Sunday. 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