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Original Research: COUGH |

Gender Differences in Perceptions of Urge To Cough and Dyspnea Induced by Citric Acid in Healthy Never Smokers

Peijun Gui, BS; Satoru Ebihara, MD, PhD; Masashi Kanezaki, BS; Chihiro Suda, MS; Etsuhiro Nikkuni, BS; Takae Ebihara, MD, PhD; Miyako Yamasaki, MD, PhD; Masahiro Kohzuki, MD, PhD
Author and Funding Information

From the Department of Internal Medicine and Rehabilitation Science (Ms Gui; Drs S. Ebihara and Kohzuki; and Messrs Kanezaki, Suda, and Nikkuni), Tohoku University Graduate School of Medicine, and Department of Geriatrics and Gerontology (Drs T. Ebihara and Yamasaki), Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.

Correspondence to: Satoru Ebihara, MD, PhD, Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Seiryo-machi 1-1, Aoba-ku, Sendai 980-8574, Japan; e-mail: sebihara@med.tohoku.ac.jp


Funding/Support: This study was supported by the Ministry of Education, Culture, Sports, Science and Technology, Japan [Grant 20590694, 21390219]; the Ministry of Health, Labor and Welfare [Grant 19C-2, 20S-1, H21-Choju-Ippan-005, H22-Junkanki-shi-Ippan-001]; and the Suzuken Memorial Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1166-1172. doi:10.1378/chest.10-0588
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Background:  The mechanism of the gender difference in cough reflex threshold has not been clearly elucidated. In the present study, we evaluated gender differences in the cough reflex threshold along with the perceptions of respiratory sensations, urge to cough, and dyspnea.

Methods:  Nineteen male and 20 female healthy never smokers were recruited through public postings. The cough reflex threshold and the urge to cough were evaluated by inhalation of citric acid. The perception of dyspnea was evaluated by Borg scores during applications of external inspiratory resistive loads.

Results:  The cough reflex threshold and suprathreshold to citric acid in women, as expressed by the log transformation of the lowest concentration of citric acid that elicited two or more and five or more coughs, was significantly lower than that in men. The urge-to-cough log-log slope in women (1.47 ± 0.81 point × L/g) was significantly steeper than in men (0.96 ± 0.28 point × L/g; P < .03). There were no significant differences in the urge-to-cough threshold estimated between men and women. The slope of the dyspnea Borg score change during the external inspiratory resistive loads is steeper in women (0.17 ± 0.04 point/cm H2O/L/s) than that in men (0.13 ± 0.05 point/cm H2O/L/s; P < .01). The urge-to-cough slope significantly correlated with the perception of dyspnea slope (r = 0.537; P < .01).

Conclusions:  The gender difference in cough reflex threshold accompanied the gender difference in amplification rate of respiratory sensations in the same direction. The higher central gain for common pathways for respiratory sensations may play a role in lower cough reflex threshold in women. Further studies are needed to elucidate this issue.

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