Chronic Refractory Cough and Anxiety: Neural Pathways

Chronic refractory cough (CRC) is a cough that persists for at least eight weeks following completion of treatment for sickness. This is often due to increased interoception, which is the ability to perceive internal sensations in the body, both physical and emotional. People experiencing CRC are often left feeling anxious and isolated. Several parts of the human brain serve both anxiety and cough. With similar neural pathways, anxiety could be a precursor for CRC. My review compares and contrasts the neural pathways of anxiety and cough, as well as highlights the work of interoception in these disorders and how behavioral cough suppression therapy (BCST) helps mitigate both symptoms. Studies have shown that there is a positive correlation between anxiety and interoception. When anxiety spikes, so does our awareness of interoception. This explains why we associate elevated blood pressure and rapid heart rate with being anxious. Cough is also associated with anxiety and interoception. Neural pathways between cough and anxiety intertwine in the prefrontal cortex, brainstem, and other areas. There is a broad overlap between anxiety and CRC. Potential for CRC to be a symptom of chronic anxiety is high. With interoception and anxiety being closely related, and also having similar neurological pathways, the two are highly connected. For future directions the options are open. There has been little research into whether anxiety could be a precursor for CRC. With more research into this topic, the potential to catch CRC before it even starts could be increased for many individuals.