Chronic Cough in Adults: A Contemporary Review of Cough Hypersensitivity Syndrome and Clinical ManagementChronic Cough in Adults: A Contemporary Review of Cough Hypersensitivity Syndrome and Clinical Management

OBJECTIVE: To synthesize evidence on the causes, assessment, and management of adult chronic cough, emphasizing cough hypersensitivity, treatable traits, and a mechanism-based clinical approach. DATA SOURCES: PubMed/MEDLINE and the Cochrane Library were searched for English-language literature published from January 2015 through September 2026, supplemented by reference-list review and selected earlier seminal studies. STUDY SELECTIONS: Priority was given to international guidelines, consensus statements, systematic reviews, meta-analyses, randomized trials, and major clinical reviews addressing chronic cough, refractory or unexplained cough, cough hypersensitivity, laryngeal and reflux-associated disorders, treatable traits, and emerging antitussive therapies. RESULTS: Chronic cough commonly reflects overlapping respiratory, upper-airway or laryngeal, reflux-associated, medication-related, and neural mechanisms. Cough hypersensitivity is increasingly recognized as an important feature, particularly in refractory or unexplained chronic cough, but should not be assumed to explain every presentation. Inducible laryngeal obstruction is appropriately considered within upper-airway and laryngeal disorders. Gastroesophageal reflux disease and laryngopharyngeal reflux may overlap in patients with cough, although causal attribution is often difficult and the two conditions should not be regarded as interchangeable diagnoses. Initial evaluation should include structured history taking, physical examination, identification of red flags, chest radiography, spirometry, and targeted assessment of treatable traits. Persistent symptoms despite appropriate management may indicate refractory or unexplained chronic cough associated with ongoing neural sensitization. CONCLUSION: Current evidence supports an individualized, mechanism-based approach that prioritizes identification and treatment of relevant diseases and treatable traits while recognizing cough hypersensitivity as a potential therapeutic target. Emerging peripheral neural therapies may broaden future treatment options for refractory chronic cough.