Transforming treatment for chronic cough

Understanding of chronic cough is being transformed through Manchester-led research that combines respiratory medicine, neuroscience and digital technology to uncover the mechanisms behind the condition, improve how cough is measured and support the development of the first treatments designed specifically to treat it.

Most people experience a cough at some point in their lives; it usually disappears within a few weeks as an infection clears. But for millions of people worldwide, coughing becomes a chronic condition that can persist for months or even years.

Why treat chronic cough?

Chronic cough is generally defined as a cough that lasts longer than eight weeks. While many cases are linked to conditions such as asthma, chronic obstructive pulmonary disease (COPD), lung fibrosis or smoking, some patients continue to cough despite treatment and without an obvious cause that can be addressed.

This is known as refractory chronic cough, and can have a major impact on quality of life. Some patients cough hundreds, or even thousands, of times each day, affecting sleep, work, social interactions and mental wellbeing.

Despite affecting around one in ten people, chronic cough has often been overlooked as a serious health condition. Patients can live with symptoms for years before reaching specialist services, while treatment options have historically been limited. Research also suggests women are disproportionately affected, and access to specialist cough care varies across the UK.

Understanding what causes chronic cough

One of the biggest challenges in respiratory medicine is understanding why some people develop persistent coughing when other people don't.

Research suggests that refractory chronic cough may be linked to changes within the nervous system. Rather than being driven solely by disease in the lungs, the condition appears to involve increased sensitivity in the nerves of the airways and in the brain pathways responsible for controlling cough.

To investigate this, researchers use a range of techniques including cough challenge testing, airway biopsies and functional MRI brain imaging. Together, these approaches help build a clearer picture of the biological processes involved and how they may differ between patients.

Understanding these mechanisms is important because it may reveal new therapeutic targets. By identifying the pathways responsible for triggering persistent coughing, researchers hope to develop treatments that are more effective, more targeted and associated with fewer side effects.

Measuring cough and developing new treatments

Developing new treatments requires researchers to accurately measure whether symptoms improve. Historically, this has been one of the major challenges in chronic cough research because assessments have often relied heavily on patient reporting.

To address this, Dr Jacky Smith and her multidisciplinary research team at The University of Manchester developed a semi-automated cough monitoring system capable of objectively measuring cough frequency over a 24-hour period. The technology combines specialised hardware with digital signal processing software, and was later commercialised through collaboration with respiratory diagnostics company Vitalograph. It has since been used in more than 50 clinical trials worldwide, and has become an important tool for evaluating potential new therapies.

The ability to measure cough accurately has helped transform clinical research in the field. Reliable data allows researchers to determine whether new medicines are genuinely improving symptoms and provides the evidence needed to support regulatory approval.

This work contributed to one of the most significant advances in chronic cough research: the development of gefapixant, the first drug specifically designed to treat refractory chronic cough. For decades, patients with severe chronic cough had no treatment developed specifically for their condition. 

The arrival of gefapixant marked an important milestone as the first licensed therapy for refractory chronic cough. However, access remains limited, with the drug currently available privately in the UK and more widely in Japan. Manchester researchers are now involved in international trials of next-generation treatments that could help make effective cough therapies more widely accessible in the future.

Looking ahead

The future of chronic cough treatment is likely to involve a wider range of therapies designed to target different biological mechanisms.

Researchers increasingly recognise that refractory chronic cough is not the same in every patient. Just as different types of pain require different treatments, different forms of chronic cough may require different therapeutic approaches.

Alongside developing new medicines, Manchester researchers are working to improve access to specialist care and ensure patient experiences continue to shape research priorities. Patient advisory groups help inform study design, while public engagement initiatives such as Let's Talk About Cough aim to improve understanding of the condition and its impact on everyday life.

As this work continues, the goal is not only to develop more effective treatments, but also to ensure people living with chronic cough are recognised, supported and able to access the care they need.