TY - JOUR T1 - Cough hypersensitivity syndrome: towards a new approach to chronic cough JF - European Respiratory Journal JO - Eur Respir J SP - 1103 LP - 1106 DO - 10.1183/09031936.00150614 VL - 44 IS - 5 AU - Roger Escamilla AU - Nicolas Roche Y1 - 2014/11/01 UR - http://erj.ersjournals.com/content/44/5/1103.abstract N2 - Although cough is a highly frequent motive for visiting the doctor among both adults and children in primary care [1, 2], it usually resolves spontaneously within a few days or weeks. Conversely, chronic cough, broadly defined as cough persisting for more than 8 weeks, is often a more difficult clinical situation from both diagnostic and therapeutic perspectives [3]. In many patients, the anatomical diagnostic workup introduced almost 40 years ago [4] rapidly unmasks a likely underlying cause, the involvement of which is confirmed by the effectiveness of aetiological treatment. However, in some cases, the initial workup does not reveal any convincing aetiology and cough remains refractory to treatments; the proportion of patients with so-called idiopathic cough varies markedly between series (0–46%) [5], leading authors to question whether this condition exists or is only the consequence of insufficient diagnostic workup, which should include various therapeutic trials before concluding as to the idiopathic nature of cough [6]. Whatever the answer is, such situations may be worrying, as, in parallel, chronic cough is a significant cause of quality-of-life impairment [7].It has been hypothesised that some, if not all, cases of chronic refractory/idiopathic cough may belong to a specific phenotype and share some common pathophysiological mechanism, namely hypersensitivity of the cough reflex [6]. As such hypersensitivity is not restricted to idiopathic cough, it has been proposed that, in general, chronic cough is the result of an interaction between intrinsic cough reflex abnormalities (i.e. hypersensitivity) and aggravating factors such as angiotensin-converting enzyme (ACE) inhibitors, gastro-oesophageal reflux disease (GORD), upper airway disorders, eosinophilic airway diseases and cigarette smoke/chronic obstructive pulmonary disease (COPD) [5]. The term “cough hypersensitivity syndrome” (CHS) was then proposed [8] to name the … ER -