Female predominance in chronic cough: biological sex–related factors, mechanisms, and therapeutic targets—a narrative review

Chronic cough—defined in adults as cough lasting ≥8 weeks—shows higher prevalence in women. Accumulating evidence supports a cough hypersensitivity phenotype with peripheral and central drivers that may vary by biological sex. Evidence-based evaluation emphasizes identification and treatment of common etiologies (upper-airway cough syndrome, cough-variant asthma or eosinophilic bronchitis, and reflux-related cough) and recognition of refractory chronic cough (RCC) and unexplained chronic cough (UCC) when symptoms persist despite optimized care. Therapeutic options include behavioral and neuromodulatory approaches as well as selective antagonists of receptors, purinergic P2X (P2X3), which can reduce objective cough frequency, although taste disturbance may occur. This review summarizes factors that may contribute to female predominance—including hormonal and immune modulators, neuro-sensory processing, comorbidities, and environmental triggers—and appraises the therapeutic landscape with attention to benefits, harms, and sex-aware evidence gaps. We outline priorities for research, including standardized outcomes, sex-stratified analyses, and patient-centered measures to improve diagnosis and management for women with chronic cough. Abbreviations: ERS, European Respiratory Society; BTS, British Thoracic Society; RCC, refractory chronic cough; UCC, unexplained chronic cough. Aims: This article reviews the factors associated with the female prevalence of chronic cough, potential mechanisms, and targets for therapy. In this review, the term “sex” refers to biological sex differences, whereas sociocultural gender-related factors are discussed only when relevant.