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A group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin.
Heightened cough reflex sensitivity can be considered reversible or persistent in patients with CCHS in whom the cough is typically dry or minimally productive.
We therefore hypothesized that sub-clinical chronic airway infections might contribute to heightened cough reflex sensitivity and inflammation in patients with chronic cough [ 21- 23].
As in the Liverpool data the C5 rather than the C2 distinguished between the groups, although here the smokers and COPD patients showed similarly heightened cough responses.
Several studies show that women have heightened cough reflex to inhalation challenge with capsaicin, citric acid, and tartaric acid [ 13, 14].
A similar group of patients has been identified, characterized by upper and lower airway symptoms triggered by chemicals and scents, and heightened cough sensitivity to inhaled capsaicin; it has been suggested that these patients suffer from sensory hyperreactivity (SHR) [ 9, 10].
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Studies in guinea pigs and humans also suggest that chemosensitive afferent input from the nose or esophagus may heighten cough sensitivity via central interacting mechanisms [ 64- 66].
Perhaps heightened awareness of coughing occurs in the context of breathlessness, or because coughing from restricted lung volumes requires greater effort.
In these disorders, cough reflex sensitivity is heightened while patients are coughing and becomes normal on successful treatment [ 3].
The vaccination programme is only temporary to deal with the heightened risk of whooping cough infection during this outbreak.
The cough threshold is lower in females than in males, illustrating that the cough sensitivity is heightened in females [ 77, 78].
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