CME Information


Needs Assessment

The impact of cough on health is substantial. The United States Department
of Health and Human Services (DHHS) has reported that cough is the most
common complaint for which patients in the US seek medical attention.¹

Better understanding the pathophysiology underlying the cough reflex and
its clinical significance in a wide range of conditions has been the directive
of global research efforts as indicated by the increase in cough-related
research in the past decade (frequently collated into larger publications –
see references 2-5) as well as the publication of multiple cough
management guidelines, including those of the American College of
Chest Physicians (ACCP) in the US.^6-10

These publications and current guidelines provide a useful framework
for cough management, summarizing current knowledge of the etiology
and approaches to therapy. However, more discussion of basic and
clinical research is needed. Questions remain – for example, there is a
need to better understand the diagnostic role of noninvasive airway
inflammation measurement as well as optimal treatments for cough
associated with different conditions, such as postinfectious cough vs.
cough due to gastroesophageal reflux disease vs. chronic cough
in immunocompromised hosts. Conversations are also needed to better
define psychogenic cough and, also, to clarify some of the psychological
aspects of difficult to treat cough. The challenges of differentiating chronic
cough in children from adults is a topic of heightened interest with
implications for treatments and, even, repercussions in terms of
vaccination.^11-13 Finally, the current database of basic and clinical research
requires regular updating and review in order to continue efforts to validate
an empiric, integrative approach to managing chronic cough.

These are continuing and collaborative discussions, and current research
efforts globally reflect peer meetings of cough experts including the First
and Second American Cough Conferences (held in June, 2007 and 2009)
and their sister program, the International Cough Symposium held in
alternating years in London. Their findings are included in the publications
cited above.^2-4

In Supplement 1 to Lung published in January 2010, Dr. Peter
Dicpinigaitis, Chairman of the American Cough Conference reflected
on the program and on the multidisciplinary challenge that pathological
cough presents.³ He noted that, by necessity, the conference speakers
represent a broad range of backgrounds: basic and preclinical science,
respiratory medicine, allergology, otorhinolaryngology, biomedical
engineering, and pediatrics. The new and emerging themes from that
meeting regarding mechanisms, diagnosis, and management of cough
are the foundation of the upcoming American Cough Conference. Notable
among these is research, clinical and basic, examining the concept that
a preexisting, heightened cough reflex may underlie the development of
chronic cough in susceptible individuals upon the superimposition of a
second, exacerbating factor such as acute viral upper respiratory tract
infection or gastroesophageal reflux, whereas in others with less baseline
cough reflex sensitivity, identical triggers will not result in the onset of
cough.¹⁴ Other emerging areas of inquiry identified by the faculty and
attendees include the association of cough with sleep, exercise, and
laryngeal sensory neuropathy and the role of the TRP family of ion channels
as a potential target for developing antitussive drugs. Whereas the TRPV1
ion channel has received significant attention in the past,¹⁵ the TRPA1 channel
is a novel and particularly exciting area of investigation. Indeed, the urgent
need for new and better antitussive drugs remains a recurrent theme that
will be expanded in the upcoming meeting.

Better understanding cough and its management, especially chronic
persistent cough, requires ongoing collaboration and communication
among the scientists and clinicians. The American Cough Conference is
a critical partner in this conversation, providing casual and formal
discussions to help shape future directions in cough research and
management.

References
1. Cherry DK, Hing E, Woodwell DA, Rechtsteiner EA (2008). National Ambulatory Medical
Care Survey: 2006 summary. Natl Health Stat Report 3:1-39.
2. Dicpinigaitis PV, Ed. The First American Cough Conference, June 2007. Lung 2008; 186
(Suppl 1, January).
3. Dicpinigaitis PV, Ed. The Second American Cough Conference, June 2009. Lung 2010; 188
(Suppl 1, January).
4. Chung KF, Widdicombe J, Eds.. The 2008 Fifth International Cough Symposium.
Pulmonary Pharmacol Therap 2009; 22(2, April).
5. Altman KW, Irwin RS, Eds. Cough: An interdisciplinary problem. Otolaryngologic Clinics of
North America 2010; 43(1).
6. Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough: American
College of Chest Physicians (ACCP) evidence-based clinical practice guidelines. Chest 2006;
129(1 Suppl).
7. Gibson PG, Chang AB, Glasgow NJ, et al. CICADA: Cough in Children and Adults: Diagnosis
and Assessment. Australian cough guidelines. Medical Journal of Australia 2010; 192(5 Mar).
8. Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment
and management of cough in children. Thorax 2008; 63: Suppl 3: Apr.
9. Morice AH, Fontana GA, Belvisi MG, et al. ERS guidelines on the assessment of cough. Eur
Respir J 2007; 29(6):1256-76.
10. Committee for the Japanese Respiratory Society Guidelines for Management of Cough.
The Japanese Respiratory Society guidelines for management of cough. Respirology 2006;
11 Suppl 4:S135-86.
11. Goldsobel AB, Chipps BE. Cough in the pediatric population. J Ped 2010; 156(3):352-8.
12. Vassilev ZP. Kabadi S. Villa R. Safety and efficacy of over-the-counter cough and cold
medicines for use in children. Expert Opinion on Drug Safety 2010; 9(2):233-42.
13. Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R. Does this coughing adolescent
or adult patient have pertussis? JAMA 2010; 304(8):890-896.
14. McGarvey L, McKeagney P, Polley L, MacMahon J, Costello RW. Are there clinical features
of a sensitized cough reflex? Pulm Pharmacol Ther 2009; 22:59–64.
15. McLeod RL, Correll CC, Jia Y, Anthes JC. TRPV1 antagonists as potential antitussive agents.
Lung 2008; 186 (Suppl 1): S59-65.


Learning Objectives:
After attending the American Cough Conference, participants will be able to:
1. Review the major recent developments in clinical and basic cough research.
2. Describe the emergence of the concept of the cough hypersensitivty
syndrome as an etiology of chronic cough.
3. Apply a multidisciplinary approach to the evaluation and treatment of chronic cough.
4. Discuss new developments in the pharmacology of cough and potential new antitussive agents.


Target Audience
This activity is designed for health care professionals who treat and study cough.


Accreditation
This activity has been planned and implemented in accordance with the
Essential Areas and policies of the Accreditation Council for Continuing
Medical Education through the joint sponsorship of Medical Education
Resources and TREAT Education, LLC. Medical Education Resources is
accredited by the ACCME to provide continuing medical education
for physicians.

Physician Accreditation
Medical Education Resources is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to sponsor
continuing medical education for physicians.

Credit Designation
Medical Education Resources designates this educational activity for a
maximum of 11.5 AMA PRA Category 1 credits™. Physicians should
only claim credit commensurate with the extent of their participation
in this activity.

This activity is jointly sponsored by
Medical Education Resources and TREAT Education