Emerging drugs in the treatment of chronic cough

ABSTRACT

Introduction

Chronic cough is a debilitating condition that is among the most common reasons for seeking medical attention yet remains challenging to manage. Identifying an underlying respiratory, nasal, or upper gastrointestinal disease triggering cough is the first step in assessment, but once this has been ruled out or adequately treated, many patients remain troubled with chronic cough.

Areas covered

This narrative review discusses the role of existing treatments and describes the current research landscape for the development of new therapies for chronic cough greater than 8 weeks that is refractory (RCC) or unexplained (UCC). The literature search includes published studies found on pubmed and conference abstracts until 2023.

Expert opinion

RCC/UCC can occur due to neuronal dysregulation of the vagus nerve or central nervous system. Hence, novel anti-tussives have targeted ion channels involved in the neuronal signaling which triggers cough. Although some therapies targeting receptors such as TRPV1 have failed to show efficacy, P2X3 antagonists have emerged as the most promising therapy for patients impacted by chronic cough. Disease-specific therapies such as for idiopathic pulmonary fibrosis are in early development.

KEYWORDS:

• Chronic cough
• refractory chronic cough
• novel therapy
• neuromodulator
• P2X3 antagonist

Declaration of interest

N Diab is funded by the Canadian Asthma, Allergy and Immunology Foundation Type II Inflammation award supported by Sanofi Genzyme, and the Canadian Institute of Respiratory Health – Canadian Lung Foundation Fellowship award, and reports personal fees from AstraZeneca, outside of the submitted work.

M Kolb declares research funding for pre-clinical work from Boehringer Ingelheim and Pieris, and research funding for clinical work from Roche; consulting fees from Boehringer Ingelheim, Roche, Horizon, Cipla, AbbVie, Bellerophon, Algernon, CSL Behring, United Therapeutics and LabCorp; payment or honoraria from Roche, Novartis and Boehringer Ingelheim; payment for expert testimony from Roche; participation on a Data Safety Monitoring Board or Advisory Board for United Therapeutics and LabCorp. I.S. is currently supported by the E.J. Moran Campbell Early Career Award, McMaster University and reports grants from Merck, GSK and MITACS and speaker and/or consulting fees from Merck, GSK, AstraZeneca, Roche, Genentech and Respiplus.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.