Unexplained and Refractory Chronic Cough: Getting the Multidisciplinary Team on the Same Page for Evaluation, Monitoring, and Treatment


Mandel R. Sher, MD
Founder, Sher Allergy Specialists
Founder, Center for Cough, Largo, FL
Clinical Professor of Medicine and Pediatrics, Division of Allergy & Immunology, University of South Florida, Morsani College of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
Mandel R. Sher, MD

Mandel Sher, MD is a Professor of Medicine and Pediatrics at the University of South Florida Morsani College of Medicine, Division of Allergy & Immunology and John Hopkins All Children’s Hospital in St. Petersburg, Florida. Dr. Sher has trained over 150 fellows, and has established the Center for Cough in 2009, which is embedded in the Sher Allergy Specialists which was established in 1984. The Center has seen over 2,000 patients with chronic refractory and unexplained cough, and is a leading investigator for clinical trials of novel antitussives. Dr. Sher is involved in multiple stages of cough drug development. He is a Fellow of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy Asthma and Immunology (ACAAI), and board-certified in Allergy & Immunology and Pediatrics. Dr. Sherreceived his MD from Northwestern University Feinberg School of Medicine, completed his residency at Duke University School of Medicine, and post graduate training at Harvard University and the University of Michigan.

Statement of Need

Chronic cough, defined as a cough lasting 8 weeks or more, affects nearly 10 percent of the global adult population. More than a nuisance, chronic cough negatively impacts health-related quality-of-life and has physical, psychological, social, and financial implications due to symptoms, repetitive medical consultations, and fruitless investigations. In some cases, treating an underlying condition such as asthma or gastroesophageal reflux disease (GERD) will mitigate the problem, but many patients continue to cough despite optimal treatment – a condition known as “refractory chronic cough,” or RCC. There are also patients with chronic cough who have no identifiable associated condition, a so-called “unexplained chronic cough,” or UCC.  Randomized controlled trials have now identified P2X3 receptor antagonists as a safe and efficacious strategy to target the distinct pathophysiology associated with RCC/UCC. 


In this CME Outfitters “Clinical Clues” series, based on the popular escape room game concept, clinicians are challenged to gather clues in each of four virtual practice environments by learning about key concepts, current treatments, and new/emerging  strategies related to chronic cough management. Successfully answering questions allows participants to collect clues needed to unlock subsequent stages. Chronic cough expert, Dr. Mandel Sher, offers practical commentary and management tips along the way. 

Learning Objectives

At the conclusion of this activity, learners will be able to better:

  • Utilize appropriate tools to assess cough frequency, severity, and impact on QoL in monitoring treatment success for patients with chronic cough
  • Incorporate patient-centric, evidence-based guidance to the differential diagnosis of chronic cough etiologies in a multidisciplinary, collaborative, and systematic manner
  • Identify the characterization and clinical features of patients with UCC/RCC
  • Evaluate recent and emerging data on the efficacy and safety of agents in trials for UCC/RCC

Financial Support

Supported through an independent educational grant from Merck Sharp & Dohme Corp..

Target Audience

Primary care physicians, general practitioners, pulmonologists; allergists; immunologists; ENTs; and gastroenterologists as well as nurse practitioners (NPs), physician associates (PAs), nurses, and pharmacists managing patients in these settings.

Credit Information

Jointly Accredited Provider

In support of improving patient care, CME Outfitters, LLC, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Interprofessional (IPCE) 1.0

This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) Credit for learning and change.

Physicians (ACCME) 1.0

CME Outfitters, LLC, designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses (ANCC) 1.0

This activity is designated for 1.0 contact hour.

Note for California Nurses

This continuing nursing education activity was approved by the California Board of Registered Nursing. CME Outfitters, LLC’s provider number is CEP15510.

Pharmacists (ACPE) 1.0

This application-based activity is approved for 1.0 contact hour (0.10 CEUs) of continuing pharmacy credit.


CME Outfitters, LLC, has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.00 AAPA Category 1 CME credits. Approval is valid until 11/17/2024. PAs should only claim credit commensurate with the extent of their participation.


Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 medical knowledge MOC point in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

MIPS Improvement Activity

Completion of this accredited CME activity meets the expectations of an Accredited Safety or Quality Improvement Program (IA_PSPA_28) for the Merit-based Incentive Payment Program (MIPS). Clinicians should submit their improvement activities by attestation via the CMS Quality Payment Program website.

Royal College MOC

Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “CME in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Disclosure Declaration

Dr. Sher reports the following financial relationships:

Advisory Board: Bayer Corporation; BELLUS Health Inc.; Merck & Co., Inc.; NeRRe Therapeutics; Nocion Therapeutics, Inc.; and Shionogi Inc.
Consultant: Soundable Health, Inc.
Research Support: Merck & Co., Inc.
Speakers Bureau: Merck & Co., Inc.


The following individuals have no financial relationships to disclose: 

Jeffrey Helfand, DO (Peer Reviewer)
Albert Eubanks, Jr., RN (Peer Reviewer)
Mary Gleason, PhD (Planning Committee)
Warren Beckman (Planning Committee)
Susan H. Yarbrough, CHCP (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

Obtaining Credit

Post-tests, credit request forms, and activity evaluations must be completed online (requires free account activation), and participants can print their certificate or statement of credit immediately (70% pass rate required). This website supports all browsers except Internet Explorer for Mac. For complete technical requirements and privacy policy, visit our Privacy & Confidentiality page.

Questions about this activity?

Call us at 877.CME.PROS (877.263.7767).



Unexplained and Refractory Chronic Cough: Getting the Multidisciplinary Team on the Same Page for Evaluation, Monitoring, and Treatment
Event Date: 11/17/2023 at 5:00 am EST