Cough: acute and chronic

Cough: acute and chronic

Pulmonary Pharmacology & Therapeutics 17 (2004) 327 www.elsevier.com/locate/ypupt Editorial Cough: acute and chronic The Third International Symposi...

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Pulmonary Pharmacology & Therapeutics 17 (2004) 327 www.elsevier.com/locate/ypupt

Editorial

Cough: acute and chronic The Third International Symposium on Cough was held at the National Heart and Lung Institute, Imperial College School of Medicine, London, on 24–26 June 2004. It built on the success of the two previous symposia and, although the title was slightly different, dealt with much the same themes. It brought together an international group of clinicians, clinical scientists, pharmacologists, physiologists and other scientists from industry and academia. We wished to update our knowledge of the basic physiological and pharmacological mechanisms of cough, to identify the main advances and problems in understanding cough in the clinic and in community practice, and as far as possible to relate the two to each other. To judge by the numbers attending, the excellence of the talks, the popularity of the posters, and the vigour of the discussions, the Symposium was a success. The sessions on basic physiology and pharmacology of cough established the important progress being made in this field, in particular demonstrating the mechanisms of hypersensitivity of cough seen in many airway and lung diseases, and the underlying remodelling of the airway structures related to these changes. Basic scientists are revealing a complex mechanism for cough, involving many afferent pathways, brainstem interactions and cerebral cortical influences. It seems certain that when these basic science developments filter through to the clinic, we will have a more complete understanding of cough in patients and its treatment. On the clinical side, there were lively discussions about what happens, or may not happen, to cough in postnasal drip, gastro-oesophageal reflux and chronic obstructive pulmonary disease. But a mystery remains: in many or most airways’ diseases the cough reflex is sensitized. What is the advantage if any of this sensitization, or is it just an irritation for the patient? As far as possible the gist of these discussions has been summarized in this Special Issue of Pulmonary Pharmacology & Therapeutics. The advances in clinical and basic research have led to great and varied efforts to develop new therapeutic

approaches to cough; although most of these advances are still on the computer screen, some will almost certainly end up in the pharmacy. We are therefore still looking for more effective antitussives. For the first time ‘Thematic Discussions’ were introduced. The first was on ‘Idiopathic Cough’, since published literature suggests that this condition is either virtually nonexistent or extremely common. The issue may not have been resolved at the Symposium, but the discussions were hectic and informative. There was also a Thematic Discussion on ‘Downregulation of Cough’; nearly all publications stress the hypersensitivity of cough in airways’ diseases but, as well as with the use of antitussives, there is a growing list of conditions where cough is weakened or absent, and consideration of these conditions should give insights into mechanisms of cough and its therapy. The administration of the Symposium was very efficiently conducted by the Events Office of the National Heart and Lung Institute, and we especially thank Catherine Walker for her help. The meeting was generously supported by AstraZeneca and GlaxoSmithKline, with welcome contributions also from Novartis and UCB. We are very grateful to Tim Higenbottam (AstraZeneca) for his encouragement and advice, and to Clive Page (King’s) and Netty Vreugdenhil (Elsevier) of the journal Pulmonary Pharmacology & Therapeutics for agreeing to publish the proceedings as a Special Issue. Kian Fan Chunga,*, John Widdicombeb Department of Thoracic Medicine, Imperial College School of Medicine, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK b 116 Pepys Road, London SW20 8NY, UK E-mail addresses: [email protected]; [email protected] a

Received 8 September 2004

*Corresponding author. Fax: C44 207 351 81 26. 1094-5539/$ - see front matter q 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.pupt.2004.09.024