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The Seventh International Symposium on Cough: Hypertussivity and allotussivity
Pulmonary Pharmacology & Therapeutics 26 (2013) 475
Contents lists available at SciVerse ScienceDirect
Pulmonary Pharmacology & Therapeutics journal homepage: www.elsevier.com/locate/ypupt
Editorial
The Seventh International Symposium on Cough: Hypertussivity and allotussivity Chronic cough is a common symptom that can disrupt daily activities of living and work, and reduce quality of life. Therefore, there is continuous interest in the Pharmacology and Therapy of Cough as the search for more effective antitussives is being pursued. At the 2012 meeting of the Seventh International Symposium on Cough held at Imperial College London in honour of the late John Widdicombe and attended by scientists and clinicians, several presentations were given relating to our understanding of the basic cough pathways and the regulation of these pathways in chronic cough. The first review comprehensively compares the basic pathways of cough to those of pain, emphasising the similarities of peripheral and central sensitisation of these 2 symptoms leading to ‘hypertussivity and allotussivity’, and ‘hyperalgesia and allodynia’, respectively. This introduction sets the scene for the description of some of the receptors and channels that may be important in the pathogenesis of the tussive response but more importantly of the ‘hypertussivity and allotussivity’. This regulation of cough through sensory nerves of the Ad fibres or C-fibres, and through recently-discovered channels such as the acid-sensing ion channels (ASIC), transient receptor potential channels (TRP) such as TRPV1 and TRPA1, and some specific voltage-gated sodium channels are described in four reviews. They represent the hope for future antitussives but one potential bottle-neck in the development of antitussives is the lack of good predictive pre-clinical models of chronic cough. Mucus hypersecretion is an important cause of chronic cough associated with many lung diseases and recent signalling pathways of mucus generation are discussed, providing potential ways of reducing cough and intraluminal obstruction in cough associated with obstructive lung diseases such as COPD and asthma. The role of cysteinylleukotrienes in controlling the cough of cough-variant asthma is discussed and may represent the potential ‘sensitising’ effects of a lipid
1094-5539/$ – see front matter Ó 2013 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.pupt.2013.07.004
mediator on cough receptors. The importance of the higher centres in the control of cough or the ‘hypertussivity and allotussivity’ is illustrated by the review on the placebo effect and on cough suppression therapy. Interestingly, as emphasised in the first review, the imaging pictures indicate that similar brain pathways are evoke during the experience of cough as during the experience of pain that could explain the use of centrally-acting agents as antitussives such as gabapentin, amitriptyline and morphine. The last review focuses on the main clinical issue that of the recalcitrant cough and how to best approach this problem. We hope that this collection of ten reviews will provide an overview of the progress that is being made in our understanding of chronic cough in what is now being increasingly referred to as the ‘chronic cough hypersensitivity syndrome’ underpinned by the state of ‘hypertussivity and allotussivity’. Further progress in the pharmacology and therapy of chronic cough will be presented at the Eighth International Symposium on Cough to be held at Imperial College London on June 26–28, 2014.
Kian Fan Chung National Heart & Lung Institute, Imperial College London, UK E-mail address: [email protected] Brendan Canning Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA E-mail address: [email protected] Lorcan McGarvey Centre for Infection & Immunity, Queen’s University Belfast, Northern Ireland, UK E-mail address: [email protected]
Contents lists available at SciVerse ScienceDirect
Pulmonary Pharmacology & Therapeutics journal homepage: www.elsevier.com/locate/ypupt
Editorial
The Seventh International Symposium on Cough: Hypertussivity and allotussivity Chronic cough is a common symptom that can disrupt daily activities of living and work, and reduce quality of life. Therefore, there is continuous interest in the Pharmacology and Therapy of Cough as the search for more effective antitussives is being pursued. At the 2012 meeting of the Seventh International Symposium on Cough held at Imperial College London in honour of the late John Widdicombe and attended by scientists and clinicians, several presentations were given relating to our understanding of the basic cough pathways and the regulation of these pathways in chronic cough. The first review comprehensively compares the basic pathways of cough to those of pain, emphasising the similarities of peripheral and central sensitisation of these 2 symptoms leading to ‘hypertussivity and allotussivity’, and ‘hyperalgesia and allodynia’, respectively. This introduction sets the scene for the description of some of the receptors and channels that may be important in the pathogenesis of the tussive response but more importantly of the ‘hypertussivity and allotussivity’. This regulation of cough through sensory nerves of the Ad fibres or C-fibres, and through recently-discovered channels such as the acid-sensing ion channels (ASIC), transient receptor potential channels (TRP) such as TRPV1 and TRPA1, and some specific voltage-gated sodium channels are described in four reviews. They represent the hope for future antitussives but one potential bottle-neck in the development of antitussives is the lack of good predictive pre-clinical models of chronic cough. Mucus hypersecretion is an important cause of chronic cough associated with many lung diseases and recent signalling pathways of mucus generation are discussed, providing potential ways of reducing cough and intraluminal obstruction in cough associated with obstructive lung diseases such as COPD and asthma. The role of cysteinylleukotrienes in controlling the cough of cough-variant asthma is discussed and may represent the potential ‘sensitising’ effects of a lipid
1094-5539/$ – see front matter Ó 2013 Published by Elsevier Ltd. http://dx.doi.org/10.1016/j.pupt.2013.07.004
mediator on cough receptors. The importance of the higher centres in the control of cough or the ‘hypertussivity and allotussivity’ is illustrated by the review on the placebo effect and on cough suppression therapy. Interestingly, as emphasised in the first review, the imaging pictures indicate that similar brain pathways are evoke during the experience of cough as during the experience of pain that could explain the use of centrally-acting agents as antitussives such as gabapentin, amitriptyline and morphine. The last review focuses on the main clinical issue that of the recalcitrant cough and how to best approach this problem. We hope that this collection of ten reviews will provide an overview of the progress that is being made in our understanding of chronic cough in what is now being increasingly referred to as the ‘chronic cough hypersensitivity syndrome’ underpinned by the state of ‘hypertussivity and allotussivity’. Further progress in the pharmacology and therapy of chronic cough will be presented at the Eighth International Symposium on Cough to be held at Imperial College London on June 26–28, 2014.
Kian Fan Chung National Heart & Lung Institute, Imperial College London, UK E-mail address: [email protected] Brendan Canning Johns Hopkins Asthma and Allergy Center, Baltimore, MD, USA E-mail address: [email protected] Lorcan McGarvey Centre for Infection & Immunity, Queen’s University Belfast, Northern Ireland, UK E-mail address: [email protected]