WAO-ARIA consensus on chronic cough – Part 1: Role of TRP channels in neurogenic inflammation of cough neuronal pathways
Philip W. Rouadi, Samar Idriss, Jean Bousquet, Tanya M. Laidlaw, Cecilio Azar, Mona Al‐Ahmad, Anahí Yáñez, Maryam Al‐Nesf, T. Nsouli, Sami L. Bahna, Eliane Abou-Jaoude, Fares Zaitoun, Usamah M. Hadi, Peter W. Hellings, Glenis K. Scadding, Peter Smith, Mário Morais‐Almeida, René Maximiliano Gómez, Sandra Nora González Díaz, Ludger Klimek, Georges Juvelekian, Moussa Riachy, Giorgio Walter Canonica, David B. Peden, Gary Wong, James L. Sublett, Jonathan A. Bernstein, Lianglu Wang, Luciana Kase Tanno, Manana Chikhladze, Michael Levin, Yoon‐Seok Chang, Bryan Martin, Luis Caraballo, Adnan Čustović, José Antonio Ortega‐Martell, Erika Jensen‐Jarolim, Motohiro Ebisawa, Alessandro Fiocchi, Ignacio J. Ansotegui
Abstract
BACKGROUND: Cough features a complex peripheral and central neuronal network. The function of the chemosensitive and stretch (afferent) cough receptors is well described but partly understood. It is speculated that chronic cough reflects a neurogenic inflammation of the cough reflex, which becomes hypersensitive. This is mediated by neuromediators, cytokines, inflammatory cells, and a differential expression of neuronal (chemo/stretch) receptors, such as transient receptor potential (TRP) and purinergic P2X ion channels; yet the overall interaction of these mediators in neurogenic inflammation of cough pathways remains unclear. OBJECTIVES: The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on neuroanatomy and pathophysiology of chronic cough. The role of TRP ion channels in pathogenic mechanisms of the hypersensitive cough reflex was also examined. OUTCOMES: Chemoreceptors are better studied in cough neuronal pathways compared to stretch receptors, likely due to their anatomical overabundance in the respiratory tract, but also their distinctive functional properties. Central pathways are important in suppressive mechanisms and behavioral/affective aspects of chronic cough. Current evidence strongly suggests neurogenic inflammation induces a hypersensitive cough reflex marked by increased expression of neuromediators, mast cells, and eosinophils, among others. TRP ion channels, mainly TRP V1/A1, are important in the pathogenesis of chronic cough due to their role in mediating chemosensitivity to various endogenous and exogenous triggers, as well as a crosstalk between neurogenic and inflammatory pathways in cough-associated airways diseases.