Long ignored but as common as asthma, chronic cough affects between 5% and 10% of the population in France. For this pathology, which results from a neurological dysfunction, the first treatments are expected for the summer of 2023.
“My cough is only growing, I have been coughing for 15 years”, describes Edith Arnu, a bit disillusioned. This Toulouse woman was diagnosed with a chronic refractory cough because she does not respond to any treatment. She chairs the very young association of chronic coughers (ATC). “We speak of chronic cough when patients cough for more than eight weeks, which is very different from acute post-viral cough”, explains Professor Laurent Guilleminault pulmonologist at Larrey Hospital (Toulouse University Hospital).
This reference center supports an active file of 150 refractory chronic coughers each year. “Among the patients who come to consult, some have been coughing for years, notes the doctor. Sometimes this chronic cough is linked to other pathologies, such as asthma, gastroesophageal reflux, or chronic rhinitis and we then manage to relieve the patients. If this is not the case, it can become persistent and extremely penalizing; and we fall into the category of refractory chronic coughers. Patients have long been told, “it is in your head”, but we now know that this chronic refractory cough is actually due to a neurological dysfunction”, indicates the doctor.
“Today, only little mints give me relief”
Indeed apart from any pathology, cough is a reflex activity. But chronic coughers have an anomaly of this reflex. Too sensitive, it is triggered, somewhat for nothing, when they feel an odor, in the cold, or when they express themselves… Unrecognized, chronic cough remains extremely frequent. In France, it concerns between 5% and 10% of the population, which is as much as asthma! “It is estimated that up to 40% of chronic coughers are refractory”, assesses Professor Laurent Guilleminault.
Edith, who was lucky enough to be quickly referred by her attending physician to the department at Larrey Hospital, is one of them. “Unfortunately the battery of examinations I underwent revealed no other pathology in me. I even took part in a clinical trial to test a drug, but I came across a placebo. Today alone the little mints give me relief.”
If chronic cough remains a benign pathology, it has real repercussions on social life and remains very debilitating on a daily basis. “This noisy pathology pushes many patients to withdraw into themselves, notes Professor Laurent Guilleminault. Over the months, they avoid dinners, family reunions and in the Covid atmosphere in which we have been immersed for two years, the gaze of others on them has become extremely heavy.”
The hope of new treatments, a clinical study in Toulouse
However, there is currently no specific treatment. The only alternative is the prescription of neuroregulators, for example painkillers (pregabalin), antidepressants (amitriptiline) or low-dose morphine. “Patients are always hesitant to take this kind of treatment which nevertheless gives very good results with a very large risk benefit”, assures the doctor. Speech therapy also relieves those whose larynx may end up dysfunctional.
However, the situation might soon change. At the Toulouse University Hospital, a clinical study must start to test drugs that inhibit airway receptors. “This kind of treatment is already giving good results. Moreover, we hope to obtain marketing authorization for the molecule gefapixant next summer.”
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