Long ignored, chronic cough is as common as asthma, affecting between 5% and 10% of the population in France. For this pathology resulting from a neurological dysfunction, the first treatments are expected for the summer of 2023.
“My cough is getting bigger and bigger, I’ve been coughing for 15 years,” says Edith Arnu, somewhat disillusioned. This Toulouse woman was diagnosed with a chronic refractory cough because she was unresponsive to any treatment. She heads the very young Association of Chronic Coughs (ATC). “We speak of chronic cough when patients cough for more than eight weeks, which is very different from acute postviral cough,” explains Professor Laurent Guilleminault, pulmonologist at Larrey Hospital (University Hospital of Toulouse).
This reference center supports an active file of 150 refractory chronic coughs each year. “Among the patients who come to the consultation, some have been coughing for years, the doctor notes. Sometimes this chronic cough is associated with other pathologies such as asthma, gastroesophageal reflux or chronic rhinitis, and then we manage to relieve the patients. If. ” If not, it can become persistent and extremely distressing, and we fall into the refractory chronic cough category. Patients have long been told “it’s in their heads,” but we now know that this chronic refractory cough is indeed the case due to a neurological dysfunction,” says the doctor.
“Today only small peppermints give me relief”
Barring any pathology, coughing is a reflex activity. But chronic coughs have an abnormality of this reflex. Too sensitive, it’s triggered pretty much in vain when they sense an odor, in the cold, or when they’re expressing themselves… Unrecognized, chronic cough remains very common. In France, it affects between 5% and 10% of the population, which is as much as asthma! “It is estimated that up to 40% of chronic cough patients are refractory,” estimates Professor Laurent Guilleminault.
Edith, who was fortunate to be quickly referred to the Larrey Hospital department by her treating doctor, is one of them. “Unfortunately, the series of examinations that I have undergone have not revealed any other pathology in me. I even took part in a clinical trial to test a drug, but I came across a placebo.
When chronic cough remains a benign pathology, it has real repercussions on social life and remains very debilitating on a daily basis. “This noisy pathology forces many patients to withdraw into themselves, notes Professor Laurent Guilleminault. Over the months, they avoid dinners, family gatherings and in the Covid atmosphere in which we have been immersed for two years are the looks of others aimed at her.” very difficult.”
The hope for new treatments, a clinical trial in Toulouse
However, there is currently no specific treatment. The only alternative is to prescribe neuroregulators, such as pain relievers (pregabalin), antidepressants (amitriptyline), or low-dose morphine. “Patients are always reluctant to take this type of treatment, which nevertheless brings very good results with a very large risk benefit,” assures the doctor. Speech therapy also provides relief for those whose larynx may no longer be working.
However, the situation could change soon. A clinical trial has to start at Toulouse University Hospital to test drugs that inhibit airway receptors. “This type of treatment is already showing good results. We also hope to obtain marketing approval for the gefapixant molecule next summer.”