WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19

Philip W Rouadi; Samar A Idriss; Jean Bousquet; Tanya M Laidlaw; Cecilio R Azar; Mona S Al-Ahmad; Anahi Yañez; Maryam Ali Y Al-Nesf; Talal M Nsouli; Sami L Bahna; Eliane Abou-Jaoude; Fares H Zaitoun; Usamah M Hadi; Peter W Hellings; Glenis K Scadding; Peter K Smith; Mario Morais-Almeida; René Maximiliano Gómez; Sandra N Gonzalez Diaz; Ludger Klimek; Georges S Juvelekian; Moussa A Riachy; Giorgio Walter Canonica; David Peden; Gary W K Wong; James Sublett; Jonathan A Bernstein; Lianglu Wang; Luciana K Tanno; Manana Chikhladze; Michael Levin; Yoon-Seok Chang; Bryan L Martin; Luis Caraballo; Adnan Custovic; Jose Antonio Ortega-Martell; Erika Jensen-Jarolim; Motohiro Ebisawa; Alessandro Fiocchi; Ignacio J Ansotegui

doi:10.1016/j.waojou.2021.100618

WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19

World Allergy Organ J. 2021 Nov 22;14(12):100618. doi: 10.1016/j.waojou.2021.100618. eCollection 2021 Dec.

Authors

Philip W Rouadi¹, Samar A Idriss^{1

2}, Jean Bousquet^{3

4

5

6}, Tanya M Laidlaw⁷, Cecilio R Azar^{8

9

10}, Mona S Al-Ahmad¹¹, Anahi Yañez¹², Maryam Ali Y Al-Nesf¹³, Talal M Nsouli¹⁴, Sami L Bahna¹⁵, Eliane Abou-Jaoude¹⁴, Fares H Zaitoun¹⁶, Usamah M Hadi¹⁷, Peter W Hellings^{18

19

20

21}, Glenis K Scadding²², Peter K Smith²³, Mario Morais-Almeida²⁴, René Maximiliano Gómez²⁵, Sandra N Gonzalez Diaz²⁶, Ludger Klimek²⁷, Georges S Juvelekian²⁸, Moussa A Riachy²⁹, Giorgio Walter Canonica³⁰, David Peden³¹, Gary W K Wong³², James Sublett³³, Jonathan A Bernstein³⁴, Lianglu Wang³⁵, Luciana K Tanno^{6

36

37}, Manana Chikhladze³⁸, Michael Levin³⁹, Yoon-Seok Chang⁴⁰, Bryan L Martin⁴¹, Luis Caraballo⁴², Adnan Custovic⁴³, Jose Antonio Ortega-Martell⁴⁴, Erika Jensen-Jarolim^{45

46}, Motohiro Ebisawa⁴⁷, Alessandro Fiocchi⁴⁸, Ignacio J Ansotegui⁴⁹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon.
² Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France.
³ Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
⁴ Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany.
⁵ Macvia France, Montpellier France.
⁶ Université Montpellier, France, Montpellier, France.
⁷ Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, MA, USA.
⁸ Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon.
⁹ Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon.
¹⁰ Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon.
¹¹ Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
¹² INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina.
¹³ Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
¹⁴ International Cough Institute, Washington D.C, USA.
¹⁵ Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
¹⁶ Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon.
¹⁷ Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon.
¹⁸ KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium.
¹⁹ University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium.
²⁰ University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium.
²¹ Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands.
²² Department of ENT, RNENT Hospital, London, UK.
²³ Clinical Medicine Griffith University, Southport Qld, 4215, Australia.
²⁴ Allergy Center, CUF Descobertas Hospital, Lisboa, Portugal.
²⁵ School of Health Sciences, Catholic University of Salta, Argentina.
²⁶ Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, NL, Mexico.
²⁷ Center for Rhinology and Allergology, Wiesbaden, Germany.
²⁸ Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon.
²⁹ Department of Pulmonary and Critical Care, Hôtel-Dieu de France University Hospital, Beirut, Lebanon.
³⁰ Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy.
³¹ UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNS School of Medicine, USA.
³² Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China.
³³ Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, Shelbyville Rd, Louisville, KY, 9800, USA.
³⁴ University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, USA.
³⁵ Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China.
³⁶ Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France.
³⁷ WHO Collaborating Centre on Scientific Classification Support, Montpellier, France.
³⁸ Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia.
³⁹ Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa.
⁴⁰ Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
⁴¹ Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA.
⁴² Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia.
⁴³ National Heart and Lund Institute, Imperial College London, UK.
⁴⁴ Health Science Institute, Autonomous University of Hidalgo, Mexico.
⁴⁵ Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria.
⁴⁶ The interuniversity Messerli Research Institute, Medical University Vienna and Univ, of Veterinary Medicine Vienna, Austria.
⁴⁷ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan.
⁴⁸ Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See.
⁴⁹ Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.

Abstract

Background: Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR.

Objectives: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed.

Outcomes: Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.

Keywords: COVID 19; Cough phenotypes; Lower airway disease; Multifactorial cough; Obstructive sleep apnea; Reflux-cough; Type 2 inflammation; Upper airway cough syndrome.

Publication types

Review