I had a chronic cough for TEN YEARS, but now an unlikely drug has changed my life

Bethan Galliers was excited to be at the theater with friends for a play she had been wanting to see. But within minutes her pleasure was rudely interrupted by a violent coughing fit – her own.

“The more I tried to suppress it, the worse it got,” says Bethan, 56, from Manchester. ‘I was self-conscious about it, so I went into the foyer to get my cough under control before returning five minutes later.’

In fact, this experience at the theater in Salford a few weeks ago was nothing new. Bethan has been living with a chronic persistent cough for more than ten years, the medical term for a condition without a clear cause. It is a common complaint thought to affect one in ten of the population.

“I cough every day,” says Bethan, mother of two adopted teenage children.

‘Some days are worse than others depending on the cause – from eating crusty bread to switching between a hot and cold environment.

‘Strong cooking odors can also trigger my coughing. I once coughed for six hours while foreign students staying with us cooked a delicious Sri Lankan meal.’

On another occasion, she coughed uncontrollably after sitting next to a woman wearing a very strong perfume.

A chronic cough is defined as a persistent cough that lasts eight weeks or longer. More than twice as many women as men are affected (possibly due to hormonal fluctuations) and in some it can last for decades.

Some people cough almost constantly, day and night; in other cases it may occur in sudden bursts. In extreme cases, patients experience blackouts (because they have difficulty breathing), incontinence or even a rib fracture. Although common, it can often be misdiagnosed as a symptom of asthma or acid reflux, and thus may be treated incorrectly.

Experts from the University of Manchester and Imperial College London are now among those leading research into chronic cough. Jacky Smith, professor of respiratory medicine in Manchester, is leading a £3 million research project, Let’s Talk About Cough, which aims to increase understanding and awareness of the condition.

Professor Smith told Good Health. ‘Chronic cough is a condition that has only recently been recognised. People were often told that it was nothing serious and that they should just learn to live with it.’

As Bethan had to do until recently.

Although she has had hay fever and dust allergies since she was a teenager, neither explains the cough that started more than a decade ago and never went away.

“It was just a bit annoying at first, but I didn’t think it was anything special,” said Bethan, community health development coordinator.

‘I’ve talked to my doctor about it from time to time since 2012, because it wasn’t getting better. At first I was given antibiotics, but the coughing continued. My doctor couldn’t find a cause for it, so I thought I’d just have to live with it.’

But it wasn’t easy, she says: ‘I often coughed quite a lot during work meetings, especially after moving from room to room, or when coming in from outside, because of the temperature change.

‘I found myself constantly apologizing for it and colleagues would always hand me a glass of water or offer to slap me on the back. Since the pandemic, people have assumed it’s Covid, so for example if I start coughing in a shop everyone disperses.”

In fact, emerging research suggests that the condition is caused by a ‘sensitivity of the nerves that control our cough reflex’, says Professor Smith.

This explains why those affected often cough due to temperature changes or irritants in the air, such as air freshener or perfume. These trigger nerves in the throat, which send an electrical signal to the brain, causing coughing.

Normally this mechanism is intended to prevent you from inhaling dangerous chemicals, for example.

Professor Smith says: ‘Similarly, if you eat, for example, dry, crumbly food, this will stimulate the nerves in the throat that respond to mechanical stimuli. This mechanism ensures that we cough, which prevents us from choking.

‘But in patients with chronic cough, these nerves become super sensitive, so they constantly fire off responses, even to things that don’t pose a threat. Patients often come to us because their cough is ruining their lives. Usually they’ve had it for five or six years, sometimes longer.’

Dr. Samuel Kemp, a respiratory doctor at Nottingham University Hospitals NHS Trust, sees many patients with chronic coughs – often because their partner is more irritated by it than they are. “One patient had been coughing for 16 years,” he says.

The constant tension from coughing can have knock-on effects, including incontinence (especially in women), chest pain, abdominal pain and hernia.

For years, doctors had few effective treatments for the problem.

Professor Smith explains: ‘We should be saying to patients, ‘I know this is terrible, but you just have to get on with it.’ ‘

But one treatment that has recently emerged is the painkiller morphine – more specifically, morphine sulphate tablets that slowly release 5 mg (the smallest dose available) of the drug over 12 hours.

Although it is not clear how it works, one theory is that it acts on the nerves that connect the brain to the throat and airways. ‘It was first shown in 2007 to have an effect on chronic cough, but it is not licensed for this specific condition, so the doctor must take responsibility for prescribing it as an unapproved drug,’ explains Professor Smith explains. .

‘It helps about 50 percent of patients, but you have to keep the dosage very low and monitor it closely because it can be addictive, even in small doses.’

Late last year, a new drug called gefapixant was licensed for use in Britain.

This blocks a receptor called P2X3 on the vagus nerve, one of the main nerves involved in causing coughs.

In studies of 2,044 people with chronic cough lasting an average of 11 years, the drug (taken daily) reduced cough frequency by 18.5 percent, The Lancet reported in 2022.

Professor Smith explains that the drug blocks receptors in the throat that are sensitive to chemicals and temperature changes. This stops them responding to a chemical, ATP, that we all naturally have in our airways, but its levels are increased in people with chronic cough.

She says, ‘The drug effectively prevents ATP from activating those sensitive nerves. By doing this, it reduces the number of times the cough is triggered.”

However, it still needs to be approved by the NHS’s spending watchdog, the National Institute for Health and Care Excellence, before it can be rolled out on a large scale.

A second-generation version, called camlipixant, is now being tested because gefapixant may have unwanted side effects, such as a reduced sense of taste.

Meanwhile, Bethan’s condition improved after her GP finally referred her to a respiratory specialist in late 2021.

After undergoing tests to rule out other conditions, Bethan started taking the slow-release morphine tablets last September.

It reduced her coughing fits significantly, by about 40 percent, especially at night.

And earlier this year, a tiny camera was placed in her nose and throat, revealing the most likely cause of her persistent cough: inducible laryngeal obstruction, a rare throat condition that causes the vocal cords to close briefly in response to inhaling irritants . This can cause and can also cause coughing.

“The diagnosis made perfect sense as I always felt like the cough was coming from my throat and not my chest,” says Bethan.

She has since visited a speech therapist who recommended exercises to help relax her vocal cords, reducing the impact of the cough.

Bethan hopes to one day receive one of the new medications being developed to better control her cough. As she explains, “I’d like to go to theaters and cinemas without having to worry so much about coughing.”