Sex differences and predictors of objective cough frequency in chronic cough

Kelsall, Angela; Decalmer, Samantha; McGuinness, Kevin; Woodcock, Ashley; Smith, Jaclyn A.

doi:10.1136/thx.2008.106237

Cited by 131 publications

(103 citation statements)

References 43 publications

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“…This raises the possibility that similar mechanisms drive both acute and chronic coughing and one study has indeed suggested that one-third of chronic cough patients report their cough being initiated by an URTI [16]. Unlike in chronic cough [32], we did not observe any significant influence of age or sex on objective cough frequency in this study population, but the sample size may have been insufficient to detect these effects. This is, however, consistent with the finding that males and females with an acute cough have similar cough-specific quality-of-life scores, in contrast with chronic cough, where females have worse scores than males [15].…”

Section: Discussioncontrasting

confidence: 50%

Objective measurement of cough in otherwise healthy volunteers with acute cough

Sunger

Powley

Kelsall³

et al. 2012

Eur Respir J

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Cough is one of the commonest reasons for medical consultation and acute cough associated with upper respiratory tract infections (URTIs) is a global problem. In otherwise healthy volunteers complaining of cough associated with symptoms of URTI, we aimed to assess objective and subjective measures of cough and their repeatability and perform power calculations for the design of future studies to test therapies.We studied 54 otherwise healthy volunteers with acute cough (,3 weeks) (median age 22 yrs (interquartile range 21-26 yrs), 64% female, mean forced expiratory volume in 1 s 97.6¡10.5% predicted). All subjects performed 24-h ambulatory cough monitoring and reported cough frequency and severity using visual analogue scales (VAS) on 2 consecutive days. Sample size calculations were performed for crossover and parallel group study designs.Objective cough frequency was high (session 1: geometric mean 12.1 coughs?h -1 (95%CI 9.7-15.2)) and fell significantly (session 2: 9.0 coughs?h -1 (95%CI 6.9-11.6); p,0.001). Repeatability was higher for objective cough frequency (intra-class correlation coefficient (ICC)50.94, p,0.001) than reported cough frequency (daytime VAS ICC50.784, p,0.001). Crossover/parallel studies require ,15 and ,41 subjects per arm to detect a 50% reduction in cough frequency with 90% power, respectively. Acute cough frequency is highly repeatable over any 48-h period, allowing small sample sizes to be used when investigating the effectiveness of novel anti-tussives. KEYWORDS: Colds, cough monitoring, upper respiratory tract infections, viral infectionsA cute cough (,3 weeks duration) is generally caused by viral upper respiratory tract infection (URTI) [1], and cough is the commonest reason for which people seek medical attention [2][3][4]. On average URTIs affect adults two to four times a year [5][6][7] and evidence suggests that 93% of cases have an associated cough [8]. Acute cough is a global problem, costing the UK economy an estimated £979 million annually due to loss of productivity, healthcare costs and the purchase of over-the-counter (OTC) medications [9].

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Section: Discussioncontrasting

confidence: 50%

Objective measurement of cough in otherwise healthy volunteers with acute cough

Sunger

Powley

Kelsall³

et al. 2012

Eur Respir J

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“…Females have a heightened sensitivity of the cough reflex as revealed by inhalational challenge with citric acid [17,18], tartaric acid [19], and capsaicin [20]. This increased sensitivity of the cough reflex is also demonstrable in patients attending the cough clinic [21] where objectively recorded cough in females is twice that of males [18]. Together these observations would suggest that females have an increased sensitivity of the cough reflex in comparison with males.…”

Section: Discussionsupporting

confidence: 49%

“…Twice as many females as males develop a cough on angiotensin-converting-enzyme inhibitor therapy [16]. Females have a heightened sensitivity of the cough reflex as revealed by inhalational challenge with citric acid [17,18], tartaric acid [19], and capsaicin [20]. This increased sensitivity of the cough reflex is also demonstrable in patients attending the cough clinic [21] where objectively recorded cough in females is twice that of males [18].…”

Section: Discussionmentioning

confidence: 95%

A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response

et al. 2014

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Reports from individual centres suggest a preponderance of females with chronic cough. Females also have heightened cough reflex sensitivity. Here we have reviewed the age and sex of unselected referrals to 11 cough clinics. To investigate the cause of any observed sex dimorphism, functional magnetic resonance imaging of putative cough centres was analysed in normal volunteers.The demographic profile of consecutive patients presenting with chronic cough was evaluated. Cough challenge with capsaicin was undertaken in normal volunteers to construct a concentration-response curve. Subsequent functional magnetic resonance imaging during repeated inhalation of sub-tussive concentrations of capsaicin observed areas of activation within the brain and differences in the sexes identified.Of the 10 032 patients presenting with chronic cough, two-thirds (6591) were female (mean age 55 years). The patient profile was largely uniform across centres. The most common age for presentation was 60-69 years. The maximum tolerable dose of inhaled capsaicin was lower in females; however, a significantly greater activation of the somatosensory cortex was observed.Patients presenting with chronic cough from diverse racial and geographic backgrounds have a strikingly homogeneous demographic profile, suggesting a distinct clinical entity. The preponderance of females may be explained by sex-related differences in the central processing of cough sensation. @ERSpublications Chronic cough in specialist clinics have homogenous demographic profiles, suggesting single clinical entity

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“…We have developed an ambulatory system for making sounds recordings over 24 hours in ambulatory patients, which allows the objective quantification of coughing (Vitalojak; Vitalograph Ltd., Buckingham, UK). This system has provided novel insights into the predictors of cough in patients presenting with isolated chronic cough (14,15), asthma (16), and cystic fibrosis (17).…”

mentioning

confidence: 99%

Predictors of Objective Cough Frequency in Chronic Obstructive Pulmonary Disease

Sumner

Woodcock

Kolsum

et al. 2013

Am J Respir Crit Care Med

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Rationale: Cough is one of the principal symptoms of chronic obstructive pulmonary disease (COPD) but the potential drivers of cough are likely to be multifactorial and poorly understood. Objectives: To quantify cough frequency in an unselected group of subjects with COPD and investigate the relationships between cough, reported sputum production, smoking, pulmonary function, and cellular airway inflammation. Methods: We studied 68 subjects with COPD (mean age, 65.6 6 6.7 yr; 67.6% male; 23 smokers; 45 ex-smokers) and 24 healthy volunteers (mean age, 57.5 6 8.9 yr; 37.5% male; 12 smokers; 12 nonsmokers). Subjects reported cough severity, cough-specific quality of life, and sputum expectoration and performed spirometry, sputum induction, cough reflex sensitivity to capsaicin, and 24-hour ambulatory cough monitoring. Measurements and Main Results: COPD current smokers had the highest cough rates (median, 9 coughs/h [interquartile range, 4.3-15.6 coughs/h]), almost double that of COPD ex-smokers (4.9 [2. 3-8.7] coughs/h; P ¼ 0.018) and healthy smokers (5.3 [1.2-8.3] coughs/h; P ¼ 0.03), whereas healthy volunteers coughed the least (0.7 [0.2-1.4] coughs/h). Cough frequency was not influenced by age or sex and only weakly correlated with cough reflex sensitivity to capsaicin (log C5 r ¼ 20.36; P ¼ 0.004). Reported sputum production, smoking history, and current cigarette consumption strongly predicted cough frequency, explaining 45.1% variance in a general linear model (P , 0.001). In subjects producing a sputum sample, cough frequency was related to current cigarette consumption and percentage of sputum neutrophils (P ¼ 0.002). Conclusions: Ambulatory objective monitoring provides novel insights into the determinants of cough in COPD, suggesting sputum production, smoking, and airway inflammation may be more important than sensitivity of the cough reflex.Keywords: cough; smoking; sputum; neutrophils; capsaicin Chronic obstructive pulmonary disease (COPD) is a major public health problem, with a lifetime risk in smokers of 35-50% (1). By 2020, it is estimated that more than 200 million people will have COPD, and it will be the third leading cause of death worldwide. Cough (either with or without sputum) is one of the principle symptoms of COPD, along with breathlessness. Epidemiologic studies have found that the reported presence of chronic cough and mucus hypersecretion in established COPD may be linked to accelerated decline in lung function (2), more frequent exacerbations (3), and hospitalizations (4), yet little is known about the mechanisms underlying coughing (5).The potential drivers for cough in patients with COPD are multifactorial. Excessive airway mucus may provide a mechanical stimulus to coughing, especially in the presence of ciliary dysfunction, airflow obstruction, and airway collapse (caused by destruction of the supporting parenchyma), all of which impair clearance. In addition the inflammation, infection, and in some continuing exposure to cigarette smoke provide chemical stimuli capable of provok...

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Sex differences and predictors of objective cough frequency in chronic cough

Cited by 131 publications

References 43 publications

Objective measurement of cough in otherwise healthy volunteers with acute cough

Objective measurement of cough in otherwise healthy volunteers with acute cough

A worldwide survey of chronic cough: a manifestation of enhanced somatosensory response

Predictors of Objective Cough Frequency in Chronic Obstructive Pulmonary Disease

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