New cough science publications vetted and collected in one place
Why are placebo responses so high in chronic cough trials?
Key Takeaway: Placebo responses in refractory chronic cough (RCC) trials can reach up to 57% reduction in 24-hour cough frequency. This paper explores the underlying mechanisms, including true placebo effects from brain-driven cough suppression, regression to the mean, and the Hawthorne effect, as well as the challenges they create for interpreting treatment effects.
Why It Matters: High placebo responses can mask the efficacy of new therapies, complicate trial design, and increase costs. The authors propose strategies to mitigate these challenges, such as averaging multiple baseline cough measurements, carefully selecting participants, and designing trials to minimise expectation bias. These insights are essential for the development and evaluation of future RCC treatments.
What role does interoception play in understanding and treating chronic cough?
Key Takeaway: This review proposes that refractory chronic cough is not simply a symptom of another disease but a hypersensitivity disorder linked to central neural processing, specifically interoception, or how the brain perceives internal body signals. The authors argue that behavioural cough suppression therapy (BCST) may work by inducing neuroplastic changes in these central pathways, much like behavioural therapies used for urinary urge incontinence.
Why It Matters: Whilst the concept of chronic cough as a standalone disease is gaining ground, many healthcare practitioners still treat cough as a symptom of a comorbid condition. This results in exhaustive, expensive and burdensome testing to exclude diseases. Many patients remain frustrated, and this paper proposes an alternative approach.
Does long-term chronic cough drive up healthcare costs?
Key Takeaway: This large US study followed over 46,000 adults with chronic cough and found that those with symptoms persisting over three years (a proxy for refractory or unexplained chronic cough) had significantly more comorbidities and incurred much higher healthcare costs than those whose cough resolved. Adjusted total healthcare costs were over $15,000 higher per year in the persistent cough group.
Why It Matters: These findings highlight the substantial clinical and economic burden of RCC. Persistent symptoms are not only distressing to patients but are also associated with higher resource use across the healthcare system. The results highlight the potential value of effective RCC treatments, not just in improving patient quality of life, but in significantly reducing healthcare costs.
Plus…
After 25 years on the frontlines of heart failure care, Dr. Nadia Giannetti thinks cough deserves more attention.
💡 “Cough is a symptom we rarely talk about in heart failure, but maybe we should.”
Watch the interview to learn why monitoring cough could be key to predicting decompensation.
