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Persistence of chronic cough in a community-based population.

ABSTRACT: Chronic cough causes significant impairment in the quality of life and is often immune to treatment. Previous studies about its persistence have focused on patients managed in special cough clinics. Little is known about the persistence of chronic cough in unselected populations. In this prospective follow-up study, we investigated factors that predict the persistence of cough at 12-month follow-up in a community-based study of subjects with chronic cough. The first e-mail survey in 2017 included a questionnaire about current cough and its risk factors. The 264 subjects who reported chronic cough were sent a follow-up questionnaire 12?months later. The response rate was 77.7% (205 subjects), of whom 165 subjects (80.5%) still had cough in 2018. In multivariate analysis, the following baseline factors predicted the persistence of cough at 12 months; gastro-oesophageal reflux disease (adjusted OR (aOR) 5.02 (95% CI 1.10-22.83)), presence of a chemical trigger (aOR 2.88 (95% CI (1.20-7.00)), duration of cough more than 1 year (aOR 2.80 (95% CI 1.27-6.22)), frequent somatic symptoms (aOR 1.31 (95% CI 1.07-1.59)), and low number of family members (aOR 0.71 (95% CI 0.52-0.98)). In conclusion, most patients with chronic cough still suffer from cough 1?year later. The presence of gastro-oesophageal reflux disease is the main predictor for the persistence of cough.

SUBMITTER: Latti AM

PROVIDER: S-EPMC7248348 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Persistence of chronic cough in a community-based population.

Lätti Anne M AM Pekkanen Juha J Koskela Heikki O HO

ERJ open research 20200401 2

Chronic cough causes significant impairment in the quality of life and is often immune to treatment. Previous studies about its persistence have focused on patients managed in special cough clinics. Little is known about the persistence of chronic cough in unselected populations. In this prospective follow-up study, we investigated factors that predict the persistence of cough at 12-month follow-up in a community-based study of subjects with chronic cough. The first e-mail survey in 2017 include ...[more]

PMID: 32494575

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Project description:BackgroundChronic cough is a common symptom which causes significant levels of morbidity. It is becoming increasingly well characterised by research taking place in specialist cough clinics, where successful treatment rates are high. However, there is a paucity of data regarding the symptom complex of chronic cough in the community. This report details the results of a postal questionnaire survey sent to individuals requesting further information on chronic cough.Methods856 chronic cough questionnaires were sent out to members of the public who requested an information sheet following a national UK radio broadcast. Information regarding demography, history of cough, previous treatment and physical, psychological and social effects of the cough was elicited.Results373 completed questionnaires were returned. Mean age was 65.3 years (SD 12.0, range 9-88 years). 73% were female and 2% current smokers. Median duration of cough was 6.5 years. 66% had no other coexisting respiratory diagnosis, whilst 24% reported asthma. Of those who responded, 91% had consulted a general practitioner regarding the cough and of them, 85% had been prescribed some sort of treatment. 61% had seen at least one hospital specialist. Commonly reported associated physical symptoms included breathlessness (55%), wheeze (37%), fatigue (72%) and disturbed sleep (70%). Incontinence occurred in 55% of women. Similarly, the majority reported psychological effects such as anger or frustration (83%), anxiety (69%) and depression (55%). 64% felt that the cough interfered with their social life.ConclusionChronic cough causes a high level of morbidity in the community, which results in a correspondingly high rate of healthcare utilisation. Demography and symptomatology seems to be similar to that reported from specialist centres, but successful treatment of the cough was uncommon, despite a high number of medical consultations in both primary and secondary care. If understanding of this debilitating but eminently treatable condition is enhanced, management of chronic cough will improve and many patients will be helped.

Project description:RationaleSpeech language pathology is an effective management intervention for chronic cough that persists despite medical treatment. The mechanism behind the improvement has not been determined but may include active cough suppression, reduced cough sensitivity or increased cough threshold from reduced laryngeal irritation. Objective measures such as cough reflex sensitivity and cough frequency could be used to determine whether the treatment response was due to reduced underlying cough sensitivity or to more deliberate control exerted by individual patients. The number of treatments required to effect a response was also assessed.ObjectiveThe aim of this study was to investigate subjective and objective measures of cough before, during and after speech language pathology treatment for refractory chronic cough and the mechanism underlying the improvement.MethodsAdults with chronic cough (n = 17) were assessed before, during and after speech language pathology intervention for refractory chronic cough. The primary outcome measures were capsaicin cough reflex sensitivity, automated cough frequency detection and cough-related quality of life.ResultsFollowing treatment there was a significant improvement in cough related quality of life (Median (IQR) at baseline: 13.5 (6.3) vs. post treatment: 16.9 (4.9), p = 0.002), objective cough frequency (Mean +/- SD at baseline: 72.5 +/- 55.8 vs. post treatment: 25 +/- 27.9 coughs/hr, p = 0.009), and cough reflex sensitivity (Mean +/- SD log C5 at baseline: 0.88 +/- 0.48 vs. post treatment: 1.65 +/- 0.88, p < 0.0001).ConclusionsThis is the first study to show that speech language pathology management is an effective intervention for refractory chronic cough and that the mechanism behind the improvement is due to reduced laryngeal irritation which results in decreased cough sensitivity, decreased urge to cough and an increased cough threshold. Speech language pathology may be a useful and sustained treatment for refractory chronic cough.Trial registrationAustralian New Zealand Clinical Trials Register, ACTRN12608000284369.

Dataset Information

Persistence of chronic cough in a community-based population.

Publications

Persistence of chronic cough in a community-based population.

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