The Burden of Cough and Phlegm in People With COPD: A COPD Patient-Powered Research Network Study

Choate, Radmila; Pasquale, Cara; Parada, Nereida A.; Prieto-Centurion, Valentin; Mularski, Richard A.; Yawn, Barbara P.

doi:10.15326/jcopdf.7.1.2019.0146

Cited by 18 publications

(17 citation statements)

References 42 publications

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“…To our knowledge, the present study is the rst to stratify CB patients according to disease severity, then to analyze the clinical characteristics of patients with mild CB vs. severe CB. A previous study classi ed the severity of cough and sputum by using CAT1 and CAT2 scores [32]. Similar to our ndings, the previous study showed that patients with more severe cough or sputum had higher mMRC scores and more frequent exacerbations.…”

Section: Discussionsupporting

confidence: 89%

Comparison of clinical characteristics between mild chronic bronchitis and severe chronic bronchitis in patients with chronic obstructive pulmonary disease

Choi

Yoon

Lee

et al. 2021

Preprint

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Background Chronic bronchitis (CB) is associated with poor outcomes in patients with chronic obstructive pulmonary disease. The aim of this study was to identify the characteristics that distinguish chronic bronchitis (CB) from non-CB. In addition, the features of mild CB vs. severe CB were compared and a cut-off level was defined according to CAT1 and CAT2 scores. Methods This study was based on the Korea COPD Subgroup Study (KOCOSS) database, constructed in a multicenter COPD cohort study that recruited patients from 54 centers. CB was defined as CAT1 and CAT2 scores ≥3; severe CB was defined as CAT1 and CAT2 scores ≥4, while mild CB was defined as either a CAT1 or a CAT2 score < 4. Baseline characteristics, 1-year exacerbation rate, and 3-year FEV1 decline were compared in non-CB vs. CB patients and in patients with mild CB vs. severe CB. Results Among the 2,162 patients enrolled in this study, 497 (23%) had CB. These patients were more likely than non-CB patients to be current smokers; they also had higher symptom and depression/anxiety scores. Lung function tests showed lower FEV1, FEV1/FVC, and DLco values in CB patients. Among CB patients, 67.6% had mild disease. Symptom and depression/anxiety scores were worse in patients with severe CB than in patients with mild CB. There were no significant differences in the lung function tests of the two groups. Analysis of 1-year exacerbation rates in CB patients and non-CB patients revealed that patients with CB more frequently had moderate-to-severe exacerbations (OR = 1.46, p < 0.01). More severe exacerbation was also present in patients with severe CB than in patients with mild CB (OR = 2.52, p = 0.01). The difference in annual FEV1 decline rate did not significantly differ either between CB patients and non-CB patients or between patients with severe CB and patients with mild CB. Conclusions CB patients had worse symptoms and lung function than non-CB patients; CB patients also had more frequent moderate-to-severe exacerbation. Patients with severe CB had higher symptom scores and more frequent severe exacerbation than did patients with mild CB.

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Section: Discussionsupporting

confidence: 89%

Comparison of clinical characteristics between mild chronic bronchitis and severe chronic bronchitis in patients with chronic obstructive pulmonary disease

Choi

Yoon

Lee

et al. 2021

Preprint

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“…Cough with or without sputum production is a common feature of COPD and is the most frequently recorded symptom in people with mild disease 46 . A recent study evaluating patient‐reported data on the burden of cough found that among 5286 subjects, those who more frequently reported cough and phlegm of greater severity also reported worse overall disease severity and quality of life 47 . Although cough is often a primary indicator of COPD, failure to recognize this is common, representing a missed opportunity for timely diagnosis and management 11 …”

Section: Addressing the Burden Of Copdmentioning

confidence: 99%

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

et al. 2021

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An individual's experience of COPD is determined by many factors in addition to the pathological features of chronic bronchitis and emphysema and the symptoms that derive directly from them. Multimorbidity is the norm rather than the exception, so most people with COPD are living with a range of other medical problems which can decrease overall quality of life. COPD is caused by the inhalation of noxious particles or gases, in particular tobacco smoke, but also by early life disadvantage impairing lung development and by occupations where inhaled exposures are common (e.g. industrial, farming and cleaning work). Wealthy people are therefore relatively protected from developing COPD and people who do develop the condition may have reduced resources to cope. COPD is also no longer a condition that predominantly affects men. The prevalence of COPD among women has equalled that of men since 2008 in many high‐income countries, due to increased exposure to tobacco, and in low‐income countries due to biomass fuels. COPD is one of the leading causes of death in women in the USA, and death rates attributed to COPD in women in some countries are predicted to overtake those of men in the next decade. Many factors contribute to this phenomenon, but in addition to socioeconomic and occupational factors, there is increasing evidence of a higher susceptibility of females to smoking and pollutants. Quality of life is also more significantly impaired in women. Although most medications (bronchodilators and inhaled corticosteroids) used to treat COPD demonstrate similar trends for exacerbation prevention and lung function improvement in men and women, this is an understudied area and clinical trials frequently have a preponderance of males. A better understanding of gender‐based predictors of efficacy of all therapeutic interventions is crucial for comprehensive patient care. There is an urgent need to recognize the increasing burden of COPD in women and to facilitate global improvements in disease prevention and management in this specific population. Many individuals with COPD follow a trajectory of both lung function decline and also multimorbidity. Unfavourable lung function trajectories throughout life have implications for later development of other chronic diseases. An enhanced understanding of the temporal associations underlying the development of coexisting diseases is a crucial first step in unravelling potential common disease pathways. Lessons can be learned from exploring disease trajectories of other NCD as well as multimorbidity development. Further research will be essential to explain how early life risk factors commonly influence trajectories of COPD and other diseases, how different diseases develop in relation to each other in a temporal way and how this ultimately leads to different multimorbidity patterns in COPD. This review integrates new knowledge and ideas pertaining to three broad themes (i) the overall burden of disease in COPD, (ii) an unappreciated high burden in women and (iii) the contrast...

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“…Coughing and sputum production are known to contribute to fatigue and sleep disturbance in COPD 39 40. We found that at baseline, objectively measured cough frequency was associated with cough-related quality of life, cough severity, sputum expectoration and fatigue score, as well as actigraphy detected sleep movements.…”

Section: Discussionmentioning

confidence: 79%

Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial

Alghamdi

Alsulayyim

Alasmari

et al. 2022

Thorax

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BackgroundOscillatory positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in patients with COPD with regular sputum production.MethodsWe enrolled stable patients with COPD, who reported sputum production every day or most days, into an assessor-blind, parallel-group, randomised controlled trial comparing 3 months of using an Acapella device against usual care (including use of the active cycle of breathing technique). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (Functional Assessment of Chronic Illness Therapy, FACIT score) and generic quality of life (EuroQol-5 Dimensions, EQ-5D). In a substudy (n=45), objective monitoring of cough and disturbance/movement during sleep were also available.Results122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38 (25–56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared with controls; MD (95% CI) 1.03 (0.71 to 2.10); (p=0.03), FACIT score 4.68 (1.34 to 8.02); (p<0.001) and EQ-5D 4.00 (0.49 to 19.75); (p=0.04). There was also an improvement in cough frequency −60 (−43 to −95) coughs/24 hours (p<0.001), but no statistically significant effect on sleep disturbance was identified.ConclusionsRegular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days.Trial registration numberISRCTN44651852.

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The Burden of Cough and Phlegm in People With COPD: A COPD Patient-Powered Research Network Study

Abstract: For personal use only. Permission required for all other uses.

Cited by 18 publications

References 42 publications

Comparison of clinical characteristics between mild chronic bronchitis and severe chronic bronchitis in patients with chronic obstructive pulmonary disease

Comparison of clinical characteristics between mild chronic bronchitis and severe chronic bronchitis in patients with chronic obstructive pulmonary disease

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial

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