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Abstract
Cough is a reflex action of the respiratory tract that is used to clear the upper
airways. Chronic cough lasting for more than 8 weeks is common in the community. The
causes include cigarette smoking, exposure to cigarette smoke, and exposure to environmental
pollution, especially particulates. Diseases causing chronic cough include asthma,
eosinophilic bronchitis, gastro-oesophageal reflux disease, postnasal drip syndrome
or rhinosinusitis, chronic obstructive pulmonary disease, pulmonary fibrosis, and
bronchiectasis. Doctors should always work towards a clear diagnosis, considering
common and rare illnesses. In some patients, no cause is identified, leading to the
diagnosis of idiopathic cough. Chronic cough is often associated with an increased
response to tussive agents such as capsaicin. Plastic changes in intrinsic and synaptic
excitability in the brainstem, spine, or airway nerves can enhance the cough reflex,
and can persist in the absence of the initiating cough event. Structural and inflammatory
airway mucosal changes in non-asthmatic chronic cough could represent the cause or
the traumatic response to repetitive coughing. Effective control of cough requires
not only controlling the disease causing the cough but also desensitisation of cough
pathways.