Lungs & Chest
Chronic Cough
Firestone Researchers Working to Improve Care for Chronic Cough
While it can feel unpleasant, a cough is your body’s main defence mechanism against threats to the lungs – whether they be chemical, thermal, or mechanical irritants. Almost everyone has experienced a cough associated with seasonal cold or flu and typically it resolves on its own. For some people, however, a cough can linger long after their acute illness has resolved. In others, a cough may present without any signs of infection or other irritant.
Despite recent advances in our understanding of chronic cough, those affected still have difficulty accessing specialist care. Fortunately, an international group of chronic cough clinicians and researchers, including members of the Firestone Institute for Respiratory Health (FIRH) at St. Joe’s, are working to make diagnosis and treatment options more accessible.
Chronic cough is defined as a cough that persists for 8 weeks or more. The global prevalence for chronic cough is estimated to be around 10 percent, though in Canada, approximately 16 percent of adults over the age of 45 are affected.
A variety of medical conditions are associated with chronic cough, including asthma, COPD, gastroesophageal reflux disease (acid reflux), and others. Oftentimes, chronic cough may appear without any associated illness.
Patients may have trouble seeking treatment as chronic cough is sometimes considered to be a trivial symptom of another disease. Combined with poor implementation of clinical guidelines, which leads to patients being over or under tested, many of those experiencing chronic cough are receiving inadequate or no care.
Did you know?
Research shows that patients with refractory chronic cough can be coughing anywhere between 200-3000 times per day. These can occur sporadically throughout the day or can occur in severe prolonged bouts of coughing. This can lead to urinary incontinence, chest pains, headaches, and loss of consciousness.
Dr. Imran Satia is an assistant professor in the Department of Medicine at McMaster University and a staff respirologist at the Firestone Institute for Respiratory Health (FIRH) – a partnership between McMaster and St. Joe’s.
At the FIRH, Dr. Satia sees patients with chronic cough, asthma, and other complex airway diseases. He has a broad research interest in understanding the mechanisms and developing treatments for these troublesome conditions.
Dr. Satia and his team at the Firestone Institute conducted a national survey on the burden of disease associated with chronic cough. Study participants reported impaired health-related quality of life, with 61 percent attributing anxiety or depression as consequences of their chronic cough. Another study conducted by Dr. Satia showed that chronic cough is associated with reduced participation in social activities, greater healthcare resource utilization, and impaired daily living.
Considering these troublesome findings, respirologists like Dr. Satia are working towards enhancing specialty cough care, developing new tools to measure cough and ultimately develop new treatments.
The NEUROCOUGH Clinical Research Collaboration (CRC), endorsed by the European Respiratory Society, was established by a group of clinician-scientists to improve the management of chronic cough. This group of 57 experts across 19 countries, including Dr. Satia, recently published guidelines to standardize procedures for clinicians currently running cough clinics and for those interested in establishing new specialty cough clinics.
“Our goal was not to mandate specific procedures for chronic cough clinics, given the global variability in patient epidemiology, referral systems, and healthcare resources,” says Dr. Satia. “Rather, the findings from the NEUROCOUGH CRC provide a consensus on the broad aims for specialist cough clinics, including key care components and activity in areas such as clinical research.”
The next step for NEUROCOUGH CRC is to develop action plans based on its findings that will support the establishment of specialist cough clinics. Not only will this ensure high quality care, but it also increases clinical research opportunities that will further our understanding of the underlying mechanisms of chronic cough and potential treatments.
Dr. Satia is currently the principal investigator on studies testing new cough treatments that target receptors on nerve endings in the airways (P2X3, TRPA1, sodium channels), as well as another new drug (nalbuphine) that suppresses coughing in the brain where research has shown there is evidence of abnormal pathways involved in coughing.
Did you know?
Dr. Satia is part of a Firestone-led research team that was recently awarded $2 million to study the role of mucus plugs in asthma, COPD, and chronic cough.
Recently, Dr. Satia was awarded the ERS Mid-Career Gold Medal in Chronic Cough and a $1 million scholar’s grant from the National Sanitarium Association (NSA). In addition, Elena Kum – an MD/PhD student at McMaster and the Firestone currently supervised and mentored by Dr. Satia – led the development of the McMaster Cough Severity Questionnaire. This work was recently published in the European Respiratory Journal and will be available for clinicians and industry partners to use to assess cough severity.
The efforts of Dr. Satia and his colleagues in Hamilton and on the international stage have solidified the Firestone Institute as a leader in chronic cough diagnosis, treatment, understanding the scientific reasons for cough, and testing new treatments.