Unraveling the neuro-immune axis in cough hypersensitivity: from pathogenesis to synergistic management

Cough Hypersensitivity Syndrome (CHS) is a pathological condition characterized by an overreactive nervous system that responds to even weak stimuli. The disease develops due to a compromised epithelial barrier in the airways, which activates immune signals through P2X3 and TRP ion channels on nerve fibers. Additionally, central sensitization occurs in the brain, where inhibitory networks are remodeled and the natural "cough brake mechanism" fails. Diagnosis is recommended using AI-powered cough monitoring and multidimensional patient-reported outcomes. Treatment involves selective P2X3 antagonists, which require careful safety monitoring. The optimal approach combines targeted pharmacotherapy with behavioral interventions, such as speech-language pathology, within a multidisciplinary team framework.