慢性咳嗽:末日即将来临?

IF 2.3 Q2 RESPIRATORY SYSTEM Breathe Pub Date : 2023-12-01 Epub Date: 2024-02-13 DOI:10.1183/20734735.0165-2023
Barnaby Hirons, Richard Turner, Peter S P Cho, Surinder S Birring
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引用次数: 0

摘要

慢性咳嗽(持续时间超过 8 周)是一种常见病,对社会心理有很大影响。尽管人们按照严格的指南做出了巨大努力,但许多患者的慢性咳嗽仍然是难治性或原因不明(RU-CC)。最近的研究表明,咳嗽超敏反应在 RU-CC 中起着重要作用,包括吸入性咳嗽挑战测试、功能磁共振成像和气道神经活检所提供的神经病理生理学证据。随着咳嗽测量方法的改进,这些知识也与包括加巴喷丁在内的神经调节药物的再利用以及非药物治疗的证据同步发展。最重要的是,现在已经有了专门治疗慢性咳嗽的新型药物。P2X3 受体拮抗剂 gefapixant 是欧洲批准的第一种此类药物。然而,挑战依然存在。慢性咳嗽领域需要更可靠的流行病学数据、更先进的诊断工具、进一步设计完善的临床试验(考虑安慰剂的影响)以及副作用最小的治疗方法。为应对这些挑战,需要建立新型慢性咳嗽登记处、改进国际疾病分类(第 10 次修订)编码、提供基因检测方案以及开展进一步的机理研究。这篇 "视点 "文章讨论了这些方面的问题,并认为虽然慢性咳嗽的终结对所有患者来说并非迫在眉睫,但不断发展的前景看起来越来越乐观。
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Chronic cough: is the end nigh?

Chronic cough (lasting more than 8 weeks) is a common condition with substantial psychosocial impact. Despite huge efforts following robust guidelines, chronic cough in many patients remains refractory or unexplained (RU-CC). Recent insights support a significant role for cough hypersensitivity in RU-CC, including neuropathophysiological evidence from inhalational cough challenge testing, functional magnetic resonance imaging, and airway nerve biopsy. Along with improved approaches to measuring cough, this knowledge has developed in tandem with repurposing neuromodulator medications, including gabapentin, and evidence for non-pharmacological treatments. Most significantly, there is now a pipeline for novel classes of drugs specifically for chronic cough. The P2X3 receptor antagonist gefapixant is the first such drug to be approved in Europe. However, challenges persist. The field of chronic cough needs more robust epidemiological data, enhanced diagnostic tools, further well-designed clinical trials accounting for the effects of placebo, and treatments with minimal side-effects. Addressing these challenges are novel chronic cough registries, improved International Classification of Diseases (10th revision) coding, genetic testing options and further mechanistic studies. This Viewpoint article discusses these facets and considers how, whilst the end of chronic cough may not be imminent for all patients, the evolving landscape looks increasingly optimistic.

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来源期刊
Breathe
Breathe RESPIRATORY SYSTEM-
CiteScore
2.90
自引率
5.00%
发文量
51
审稿时长
12 weeks
期刊最新文献
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