P103 The urge to cough in copd

Abstract

IntroductionUrge to cough is a conscious perception of the need to cough. We investigated urge-to-cough, triggers and somatic sensations associated with cough in patients with COPD and compared it to patients with chronic refractory cough (CRC).MethodsWe undertook a prospective case-control study of COPD patients with chronic cough (≥8 weeks) and patients with CRC. All patients completed a 27-item structured questionnaire (Cough Hypersensitivity Questionnaire; CHQ), that has a 5-point Likert response scale to assess urge-to-cough, aggravating factors/triggers and somatic sensations (0–4; 0=never and 4=occurs all the time in relation to cough). 10 COPD patients underwent a capsaicin challenge test to provoke an urge-to-cough sensation and to assess cough reflex sensitivity. The concentration of capsaicin that elicited 2 or more coughs (C2) and 5 or more coughs (C5) was recorded.Results62 COPD and 40 CRC patients were recruited (mean(SD) age 64(11) vs 54(14) years, 48% vs 70% females, FEV1% predicted 48.2% (19.0) vs 94.1% (16.6) respectively). The top 5 cough triggers and somatic sensations in patients with COPD and CRC are summarised in Table 1. The severity of sputum trigger of cough and chest sensation associated with cough were significantly greater in COPD compared to CRC; median(IQR) sputum scores: 3 (2–4) vs 2 (1–2) and chest sensation scores: 2 (2–4) vs 1 (0–2) respectively, both p<0.01. The prevalence of urge-to-cough was higher in CRC vs COPD: 97.5% vs 75.8% respectively. The severity of urge to cough and eating/drinking trigger of cough were significantly greater in CRC compared to COPD; median(IQR) urge to cough scores: 3 (2–3) vs 2 (1–3) and eating and drinking scores: 2 (0–3) vs 1 (0–2) respectively, both p=0.02. Geometric mean(SD) C2 and C5 in COPD were 9.5 (18.2) and 10.9 (18.0) micromol.L-1. There was a significant correlation between C5 and urge to cough in COPD (rs=−0.74,p=0.02) but not with sputum trigger score (rs=−0.10,p=0.80).Abstract P103 Table 1Prevalence of triggers and somatic sensations associated with cough in COPD and chronic refractory cough. Data presented as percentage of all patientsTop 5 triggers and somatic sensations associated with coughPrevalence (% patients) COPDSputum87Chest sensation86Smoke or smoky atmosphere81Dry throat77Exercise77Chronic refractory coughUrge to cough98Tickle in throat93Cold air90Irritation in throat88Postural change88ConclusionSputum is a significant self-reported trigger of cough in COPD. In contrast, urge to cough occurs more frequently in CRC. There are likely to be multiple mechanisms of cough in COPD and further studies should investigate whether phenotyping cough on the basis of self-reported triggers and somatic sensations can guide therapy.

Assessment and Management of COPD

“…Instruct COPD patients on the technique of controlled coughing (Solomon et al, 2017). This is a cough that comes from deep within the lungs and has enough force to loosen and carry mucus through the airways without causing narrowing or collapse.…”