How this clinician-researcher is cracking the chronic cough code

Chronic cough is characterized by a persistent cough that lasts for over eight weeks, causing some people to cough more than 400 to 500 times daily. Ten per cent of the world’s population experiences this condition, with its prevalence peaking between ages 50 and 60.

In Canada, prevalence is even higher, impacting approximately 16 per cent of the population. Imran Satia, a dedicated respiratory physician and researcher at McMaster University, has spent his career seeking to understand the underlying mechanisms causing chronic cough, and has developed innovative treatments and diagnostics that can ease its impact on patients’ lives.

“Cough is the number one reason people seek medical attention and the commonest reason for referral to specialist. Its psychological and physical toll is substantial, yet there currently exists no effective licensed treatment,” explains Satia.

Through a comprehensive research journey, Satia, an assistant professor in the Division of Respirology in McMaster’s Department of Medicine, has dedicated himself to filling this treatment gap. His work aims to revolutionize the field, providing relief to countless individuals suffering from chronic cough.

An international research journey

Having obtained his medical degree from the University of Cambridge, Satia pursued post-graduate clinical training in respiratory and general internal medicine at the University of Manchester. It was there that his interest in researching the mechanisms behind chronic cough took root. During his training it became clear that while coughing serves as a protective reflex, in many cases, this reflex becomes exaggerated, resulting in persistent coughing. It became apparent that chronic cough could be caused by a neurological condition which has come to be known as cough hypersensitivity syndrome.

Satia moved to McMaster in 2018 and engaged in high quality clinical research aimed at an improved understanding of chronic cough, enhanced clinical care improvements, and devising much-needed treatments. The first objective was finding a solution for how health professionals could evaluate the severity of their patient’s coughs. To address this gap, Satia collaborated with Elena Kum, an MD PhD student at McMaster, to create a comprehensive cough severity questionnaire. The McMaster Cough Severity Questionnaire, as it came to named, is now copyrighted and is a noteworthy step toward comprehensive patient-reported outcome measurements for chronic cough evaluation.

As his clinical practice and research horizons broadened, Satia initiated clinical trials to assess real-world outcomes of individuals struggling with chronic cough. His unique expertise led to his selection as a chief investigator for pivotal phase 2 and phase 3 clinical trials, giving patients who had no success with prior treatments access to innovative therapies which block receptors on nerve endings in the lungs and prevent the reflexive cough response.

In search of data to better understand chronic coughers, Satia forged a robust collaboration with Parminder Raina, a professor in the Department of Health Research Methods, Evidence, and Impact, who is one of the principal investigators of The Canadian Longitudinal Study on Aging (CLSA). This database, comprised of 30,000 participants across Canada, played a pivotal role in Satia’s research. Analyzing data from individuals aged 45 to 85, his team uncovered the presence of depressive symptoms or psychological distress correlated with a 20 per cent higher risk of chronic cough development. Provincial variations also appeared, with Ontario reporting a 16 per cent prevalence of chronic cough, compared to a lower 10 per cent in Quebec.

“The findings from the CSLA data analysis suggest an influence of location, language, and culture on chronic cough,” mentions Satia. “What interests me further is the impacts of environmental factors like the climate and pollution. If we can delve deeper into how these factors influence the occurrence of chronic cough, we can better understand how to help prevent it.”

A promising future for chronic cough

With a solid foundation of research, Satia hopes to unite academic expertise with industry partnerships. His approach promises to provide holistic insights into chronic cough’s mechanisms, potentially paving the way for more effective treatments that can enhance the lives of countless individuals worldwide.

Imran’s efforts have recently led to him being awarded the European Respiratory Society’s inaugural Gold Medal Award in Chronic Cough, and the National Sanitarium Association (NSA) Scholar’s Award and a CIHR Planning and Dissemination grant. Imran also co-chairs the Canadian Thoracic Society Chronic Cough Working Group with Dina Brooks, also from McMaster University.