Find all editions of Cough Science News below and get access to the latest cough science developments, publications, and interviews with cough experts.
7 May 2026
Hello!
I want to start this month with something different. ATS 2026 is just around the corner (our team will be there in full force) and I'm going to spend some of this newsletter looking forward rather than back.
We typically use this newsletter to look back at the cough science of the previous month, and there's plenty of that, but ATS is one of the few moments each year when leaders in this field end up in the same building, and after going for over 40 years (I’m not sure if that makes me wise or just old) I can tell you it's where I get the clearest picture of where the field is actually heading. So I want to spend a moment on what I'm watching for.
The biggest thread I'm tracking is cough showing up as an endpoint in indication-specific drug trials, not just refractory chronic cough programs but bronchiectasis, IPF, COPD, asthma, sarcoid and more. There's Phase 2b data coming on nalbuphine extended release for IPF cough, post hoc analyses of brensocatib's effect on patient-reported symptoms in non-CF bronchiectasis, and our own interim COPD-HYFE results. Taken together, these abstracts point toward what I think is the next wave: pharma companies recognizing that if their drug improves cough alongside its primary endpoint, that matters to patients and physicians. I’m starting to see the gears churning - spanning cough as an exploratory endpoint in early clinical development to primary endpoint in Phase 4.
I'm also watching for work that pushes the methodological foundations forward: daily cough count variability and how it correlates with PROs, accuracy assessments for automated detection algorithms in real-world settings, and descriptive studies of cough dynamics in a growing list of conditions that will inform clinical trial design.
This randomized phase 2b trial evaluated extended-release nalbuphine in patients with idiopathic pulmonary fibrosis and chronic cough. Using objective digital cough monitoring, the study showed large, dose-dependent reductions in 24-hour cough frequency over six weeks, with reductions exceeding 60% at the highest dose. Improvements in patient-reported cough frequency were also seen, though less consistently and primarily at higher doses.
Why it matters
First positive phase 2 trial targeting central cough circuits rather than peripheral P2X3 receptors, with 60% objective cough reduction: genuinely impressive numbers! But six weeks tells us the drug works, not whether patients will tolerate nausea and constipation long enough for it to matter in a chronic, progressive disease. The path to approval hinges on demonstrating sustained objective cough reduction and actual durability in longer trials.
I'll be there for the entire conference along with Tamsin Chislett, Hyfe’s CEO and Clara Delhaye, Research Partnerships Associate, and you can find us at Booth 916 all day, every day. The team from Ametris will be joining us at the booth as well - swing by to see how their powerful FDA cleared technology can now also monitor cough. I'll also be there a couple of days early for the Nexus event and the Respiratory Innovation Summit.
If you'll be at ATS, just reply to this email and let's set up a time to meet. I'd love to connect.
We're also presenting two late-breaking posters:
I’m hoping to see you there!
Let’s move to the next part, and discuss what cough science brought us in April.
What the study found: In a small cross-sectional study of 18 chronic cough patients, objective 24-hour cough monitoring revealed a distinctive pattern in CANVAS patients: significantly more coughing during meals (25.8 vs 7.3 coughs/h) and at night (12.5 vs 6.8 coughs/h). But the most striking finding was the disconnect between what patients reported and what the monitor captured. CANVAS patients had higher objective cough counts yet reported lower severity on VAS scores than the non-CANVAS group. No significant correlation was found between objective cough frequency and PRO scores in either group.
Why it matters: This is a small study, but it's the first attempt to tease out differences between conditions based on objective cough time series, and the divergence between patient-reported outcomes and objective monitoring is hard to ignore. If patients with the highest cough burden are the ones reporting the lowest severity, PROs alone are missing the picture. The authors themselves note the need for further research with larger cohorts and longer monitoring periods, and that feels right. Studies like this point toward a future where continuous cough monitoring may identify disease-specific patterns that neither questionnaires nor brief recording windows were designed to catch.
What the study found: The MUCOSA trial randomized 30 patients with refractory chronic cough and eosinophilic airways disease to mepolizumab (an anti-IL-5 monoclonal antibody) or placebo, with 24-hour cough frequency measured at baseline, week 8, and week 14. Mepolizumab worked exactly as expected on its biological target, significantly reducing blood and sputum eosinophils, but did not improve cough frequency, severity, or quality of life compared to placebo. The placebo group itself dropped 37.4%.
Why it matters: There are three takeaways from this. First, in patients with refractory chronic cough and persistent eosinophilic inflammation, targeting eosinophils alone is unlikely to be the answer. Cough in this population is probably being driven by neuronal mechanisms, not the inflammation we can see in the sputum. Second, and this is where I'd push the field harder, the trial relied on three 24-hour cough recordings spread over 14 weeks. It's worth asking what we might learn if we could measure more continuously, particularly in trials where the placebo response is as large as it was here. And finally, how much of cough is due to neuronal hypersensitivity initiated by inflammation and persisting thereafter (ever had a nagging cough for months after an upper respiratory infection?). If so, a combination of drug and digital therapeutic may improve cough.
What the study found: This review maps the bidirectional relationship between chronic cough and depression. Depression incidence in chronic cough patients runs 33–53%, and severe depression triples the risk of developing chronic cough. The two conditions share neural pathways, vagus nerve, brainstem, limbic system, and are linked by overlapping neurotransmitter imbalances and a chronic inflammatory cycle involving IL-6 and TNF-α.
Why it matters: The burden of cough extends well beyond the respiratory system, and this paper quantifies how far. The implication is twofold: a therapy that objectively reduces cough may also improve a major comorbidity, and measuring that cough objectively rather than relying solely on patient-reported outcomes becomes even more important when depression is in the mix.
Will FDA's new bar post-Gefapixant actually clear the pipeline or just delay timelines? Is there room for multiple winners or will this be a winner-take-most market? What does real differentiation look like when everyone's claiming ~40% cough reduction? And what's the actual role of digital therapeutics - nice-to-have or table stakes for persistence?
We built a 52-page report to answer exactly these questions. It covers regulatory dynamics, pipeline scorecards for all 17 therapeutics in development, competitive positioning scenarios, and why the durability problem will separate winners from footnotes.
The market could reach $15B by 2035, but the path there isn't obvious and most public analyses are missing critical dynamics around specialist access, payer consolidation, and platform lock-in
The tools and the science are catching up. I think ATS is going to make that very clear.
See you there: Booth 916.
Until next month,
Peter Small, MD
Chief Medical Officer, Hyfe
