Find all editions of Cough Science News below and get access to the latest cough science developments, publications, and interviews with cough experts.
7 May 2026
Hello!
I want to open this month with three developments that sit a little outside our usual research roundup but that I think matter a great deal for where cough measurement is heading. One is a regulatory decision in Japan. The other is a conference many of you will be at within the week. And finally, the return of our Cough Science Forum.
For those of us who have spent years arguing that cough can be measured objectively and continuously, this is a very significant milestone! As far as we are aware, it is the first time an automated digital biomarker for cough detection has served as the basis for a primary endpoint in a Phase 3 pivotal trial. It is also only the second time any wearable device has been accepted as a primary endpoint in a Phase 3 study anywhere in the world.
For a field that has long judged treatment effects largely through patient-reported outcomes, this matters. A regulator has now accepted that continuous, automated cough counting can carry the weight of a pivotal efficacy readout. Good for the science, and good for the people living with chronic cough who stand to benefit from better-powered trials.
What pulmonary diseases do not involve cough?
My list is very short…
You could see the increased interest in cough this year in Orlando. Pharma teams working across COPD, bronchiectasis, IPF, and sarcoidosis were coming to us with specific questions about trial design and not whether to include cough, but how. We were having sophisticated and nuanced discussions about Hawthorne effects on cough behavior, how to normalize a rolling baseline, what day-to-day variability means for your sample size calculation. That's a different discussion than we were having two years ago.
What came through in multiple independent conversations was the gap between what patients report and what continuous monitoring actually captures. A chronic cough sponsor we walked through our Hawthorne analysis engaged with it in a way that felt qualitatively different from past meetings, less about identifying opportunities and challenges, more working through them together. A number of folks who saw our COPD exacerbation data immediately started thinking about whether a rise in cough rate could serve as a clinical trigger for intensification of care.
These aren't incremental extensions of old thinking. They're people building new frameworks in real time and I’m glad that continuous cough monitoring is driving these conversations forward.
The London Cough Conference opens in a few days, and it remains one of the most important gatherings for anyone working to advance cough science. Hyfe will be there, and there are two contributions I would point you toward.
We are presenting poster PS126, “Continuous cough monitoring surrounding COPD exacerbations: interim findings from a prospective multi-center study”. It builds on the exacerbation work some of you saw earlier this year, now with prospective, multi-center data.
I am also giving a talk, “New insights from continuous cough monitoring”, on July 16th at 17:50, as part of the session Discovery science to innovation: new approaches to monitoring cough, held in collaboration with industry partners.
Three takeaways:
If you're attending and would like to meet up, please reach out, and we'll set up a time.
On July 1st we revived the Cough Science Forum, our live virtual session where researchers working on cough come together to share data and talk through what continuous monitoring is starting to reveal across different diseases.
This first session brought three complementary datasets into one conversation. Dr Fan Chung presented 28-day continuous monitoring in refractory chronic cough that makes a real case for rethinking how we design and screen for trials. Dr Carlos Chaccour showed something I found genuinely exciting, that cough may be able to predict a COPD exacerbation as much as two weeks out. And Dr Mees Stoop brought pediatric asthma data that raises more questions than it answers, which is exactly what good early work should do.
If you missed it, the full session is available on demand.
What the study found: Following 245 patients from the Korean Chronic Cough Registry whose cough had been attributed to a specific cause, 21.6% were reclassified as refractory over about a year. The groups looked nearly identical at baseline, but transition carried an age-dependent link to cough hypersensitivity (CHQ): above roughly 50, higher CHQ scores predicted transition, and rates peaked around age 55. CHQ scores also diverged over time, improving in non-transitioners while creeping back up in those who turned refractory.
Why it matters: The authors float an "unmasking" interpretation I find plausible: in some older patients, a treatment-resistant hypersensitivity is present from the start and only surfaces once the underlying cause is controlled. If that holds, "refractory" is less a cough that developed resistance over time and more one whose defining feature was there from the start, hidden behind a treatable cause. Divergence over time is a really interesting signal to me. A registry with visits spaced months apart can see that it happened, but not when. Continuous, objective measurement is precisely the tool that could date the turn and catch it while there's still something to do about it.
What the study found: Three hundred chronic cough patients across 19 Korean respiratory centers completed four instruments (NRS, LCQ, COAT, and the Cough Hypersensitivity Questionnaire), which the authors then mapped with correlation and network analysis. The CHQ showed no significant association with the NRS at all, meaning how sensitive a cough is and how severe it feels are largely independent. Within the CHQ, "urge to cough" reached broadly across physical, psychological, and social domains, while triggers like hot air, dampness, and laughter barely correlated with anything. The patterns also differed by disease, with broader associations in asthma and bronchiectasis than in COPD and IPF.
Why it matters: This is a useful piece of evidence for something we keep bumping into: a single subjective score struggles to represent cough, because cough is not one dimension. Hypersensitivity, severity, and social burden are related but distinct, and a patient can sit very differently on each. The disease-specific patterns are the part I'd flag for anyone designing trials across indications, since it suggests the same instrument may behave differently in COPD than in asthma, which matters for how you power and interpret a study. None of this is an argument against PROs. It's an argument for measuring more than one thing, and for pairing what patients feel with what can be counted objectively.
Thank you!
Until next month,
Peter Small, MD
Chief Medical Officer, Hyfe
I'm very excited about the upcoming Cough Science Forum. We'll send more details soon!
Until next month,
Peter Small, MD
Chief Medical Officer, Hyfe
