The third issue relates to the possibility that cough may “beget” cough. In suggesting this possibility, Dr. Reich refers to our recently published study,4which suggested that the airway inflammation associated with chronic cough may be due to the trauma of coughing, and that the characteristics of the inflammation from trauma may be indistinguishable from those of the underlying disease causing cough. The clinical and research implications of our findings are twofold: investigators must be cautious when imputing pathogenetic importance to observed inflammatory changes in the airways of coughing subjects; and, as suggested by Dr. Reich, studies should be performed to determine whether a sustained trial of cough suppression might eliminate chronic cough in patients whose cough is potentially perpetuated by the trauma of coughing itself. While it is an intriguing thought that a cough self-perpetuating cycle may potentially explain some of the causes of unexplained cough, cough suppression with a potent, potentially addicting agent such as a narcotic will probably be required and theoretically will work only if the original cause of cough has disappeared. Consequently, therapeutic trials with potent cough suppressants should be conducted for limited and finite periods of time. To test this hypothesis, future research will be needed to determine which, if any, cough suppressants might be of benefit5and to determine the time period of active cough suppression. Because there is a strong suspicion that a likely cause of chronic cough was actually present in many cases mislabeled as having an unexplained cough (ie, idiopathic cough) due to incomplete or inadequate evaluation or treatment,6 clinicians should diagnose chronic cough and treat patients according to the best available evidence, such as the ACCP cough guidelines,7 before considering a trial of potent cough suppressant therapy for a putative unexplained chronic cough.