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The last decade or so has seen remarkable advances in our knowledge
of cough. This applies especially to its basic mechanisms: the
types of airway sensors, the phar- cological receptors on their
membranes, the brainstem organization of the 'cough centre', and
the involvement of the cerebral cortex in the sensations and the
vol- tary control of cough. With the exception of the last of
these, nearly all the studies have been on experimental animals
rather than humans, for obvious reasons. One group of experimental
studies has particular relevance to human patients, and that is the
demonstration of the sensitization of cough pathways both in the
periphery and in the brainstem. Similar sensitizations have been
shown for patients with chronic cough or who have been exposed to
pollutants, and it is reasonable to suppose that this is the basis
of their cough and that the underlying mechanisms are generally
similar in humans and other species. Important advances are also
being made in clinical cough research. For the three main causes of
clinical cough, asthma, post-nasal drip syndrome, and gast-
oesophageal re?ux disease, we are beginning to understand the
pathological processes involved. There remains a diagnostically
obdurate group of idiopathic chronic coughers, but even for them
approaches are being devised to clarify und- lying mechanisms and
to establish diagnoses. Perhaps surprisingly, the ?eld in which
there has been the least spectacular - vance is the therapy of
cough.
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