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7 August 2026
Hello,
In just a couple of days, our team will be at the ERS Congress. Tamsin Chislett and Asia Baginska will be there in person, meeting colleagues and taking part in conversations about cough.
We are presenting two posters this year. One looks at cough in COPD. The other examines cough variability and its relationship to patient-reported outcomes and the impact of measuring cough on how much research subjects cough (aka the Hawthorne effect), a question I find increasingly central to how we design and interpret cough trials.
What the study found: Among 147 unselected chronic cough patients assessed at an ERS NEuroCOUGH site, 61% had an objective cough frequency below 20 coughs per hour, a threshold that has been used for inclusion in some antitussive trials. Yet roughly half of those patients reported moderate or higher cough severity and meaningful health status impairment on VAS and LCQ.
Why it matters: The ≥20 coughs per hour criterion may be excluding a majority of the patients who actually walk into cough clinics, many of whom carry a real symptom burden. The authors argue trials should reconsider this threshold and explore other objective cough parameters as outcome measures. I would add that reliably detecting cough takes longer observation windows than the standard 24 hours.
What the study found: Real-world data from 205 patients treated for refractory or unexplained chronic cough at a tertiary speech pathology clinic revealed three distinct response trajectories. One group with severe baseline cough improved rapidly, reaching the LCQ minimally clinically important difference in a median 91 days, with every patient in that group crossing the threshold. Comorbid asthma predicted a slower trajectory, and 76% of the full cohort improved beyond the MCID.
Why it matters: This is the first trajectory analysis applied to behavioural therapy in chronic cough, and it makes the case that response heterogeneity is structured rather than random. Being able to spot rapid responders at baseline would change how these clinics plan treatment, and it would change enrichment strategy in behavioural trials too. The authors also flag the Hawthorne effect in their limitations, which is a question we are looking at closely ourselves.
What the study found: In a single-center randomized, double-blind, placebo-controlled trial, 68 patients with IPF and chronic cough received gabapentin titrated to 900 mg/day or placebo for 12 weeks. At the end of treatment, 73.5% of the gabapentin group achieved at least a 50% reduction in Cough Symptom Score versus 26.5% on placebo. Adverse events, mainly drowsiness, fatigue, and dizziness, occurred in 32.4% of gabapentin patients.
Why it matters: IPF-related cough is common, disabling, and largely untreated, so a positive controlled trial with a widely available, inexpensive drug is notable. The effect size is strikingly large and with a subjective primary endpoint. I would love to see how these results hold up under continuous objective monitoring. Still, this strengthens the case that centrally acting therapy has a role in fibrotic lung disease cough.
On hyfe.com, we work through the questions that come up repeatedly in conversations with sponsors and investigators. This month:
CDRH vs. CDER: Why the Difference Matters for Cough Endpoints.
Start here if you are building an endpoint strategy. The scope of your study determines which centre reviews your submission and changes what evidence you need.
Objective, continuous cough monitoring in bronchiectasis.
Where cough sits as an endpoint in a disease where it is often the symptom patients care about most.
Improving cough in low income settings was a big part of Hyfe’s genesis. Sophie ran a cough monitoring pilot in Ugandan primary care centres, nested within the R2D2 TB Network, measuring cough frequency at TB treatment initiation and again 30 days later. Having spent a good part of my career on TB, I found her account of what actually worked in the field, and what her participants asked for, very interesting!
PS: In October, we will host another Cough Science Forum, this time presenting the most recent data on cough variability and the Hawthorne effect. I’ll share more details soon!
Thank you!
Until next month,
Peter Small, MD
Chief Medical Officer, Hyfe
