Chronic cough is associated with increased reporting of autonomic symptoms

Abstract

BackgroundPatients with some neuronal hypersensitivity syndromes experience increased autonomic symptoms. Chronic cough is thought to be a neuronal hypersensitivity disorder and, therefore, may be associated with increased autonomic symptoms.Methods96 chronic cough subjects were recruited from the tertiary cough clinic based at Wythenshawe Hospital, Manchester, UK; 76 healthy controls were also recruited. Subjects were aged >18 years. Those with significant respiratory disease, significant smoking history or taking medication known to affect cough or autonomic function were excluded. Subjects completed the Composite Autonomic Symptom Score (COMPASS) 31 autonomic symptom questionnaire, the Cough Quality of Life Questionnaire (CQLQ) and a cough severity visual analogue scale (VAS).Results96 chronic cough subjects and 76 healthy volunteers were included in the final analysis. Mann–Whitney U-tests comparing COMPASS 31 scores in both groups showed that the total COMPASS 31 score was significantly higher in the patient group (median 18.4, interquartile range (IQR) 7.5–32.0) than the control group (median 3.6, IQR 1.1–9.5; p<0.001). The chronic cough subjects had significantly higher symptom scores than the healthy volunteer groups in all domains (p≤0.001) except vasomotor symptoms (p=0.770). There was a positive association between COMPASS 31 and CQLQ in the patient group (p<0.001, r=0.432) but not COMPASS 31 and VAS (p=0.227).InterpretationChronic cough patients do indeed report more frequent and severe autonomic symptoms than healthy volunteers, indicating that this population may suffer from dysautonomia. At present, it remains unclear whether this occurs as a result of the cough or whether both the cough and dysfunction are part of some wider vagal pathology.

Patient-reported experiences with refractory or unexplained chronic cough: a qualitative analysis

“… 17 , 23 , 24 We found that, for many individuals with RCC or UCC, the disruptive nature of cough was exacerbated by its unpredictability, a finding that accords with a 2021 observational study of UCC. 24 The wide range of chronic cough symptoms described in the current study, including hoarseness, fatigue, vomiting, and shortness of breath, have been widely observed in other studies of chronic cough, 17 , 24 – 29 underscoring the importance of these symptoms to patients’ experience. Two findings of the current study, to our knowledge, have not previously been reported: RCC and UCC patient subgroups experience a similar frequency of symptoms, and a patient’s symptom profile may change over time.…”

Cervical Manipulation and Koren Specific Technique Emotions Protocol in the Improvement of Intensive Nocturnal Dry Cough: A Case Report

“…Furthermore, chronic cough patients have a higher prevalence of symptoms related to autonomic nervous system dysfunction and depressive symptoms [ 4 , 22 ]. It remains unclear whether these are caused by coughing or if chronic coughing and depression are actually part of a broader pathological manifestation of vagus nerve dysfunction.…”

The burden and impact of chronic cough in severe disease

“…A recent general population study found that individuals with chronic cough were more prone to develop chronic pain, and vice versa, indicating potential common mechanisms or risk factors [28]. Among patients in a tertiary cough clinic, autonomic symptoms are more common than among healthy individuals, further supporting that common neural pathways are implicated in chronic cough [29].…”