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Original Research: COUGH |

Cough in COPD*: Correlation of Objective Monitoring With Cough Challenge and Subjective Assessments

Jaclyn Smith, MD, PhD; Emily Owen, MPhil; John Earis, MD; Ashley Woodcock, MD
Author and Funding Information

*From the North West Lung Centre, South Manchester University Hospitals Trust, Manchester; and Aintree Chest Centre, University Hospital Aintree, Liverpool, UK.

Correspondence to: Jaclyn Smith, MD, PhD, North West Lung Research Centre, Wythenshawe Hospital, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK; e-mail jacky.smith@manchester.ac.uk



Chest. 2006;130(2):379-385. doi:10.1378/chest.130.2.379
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Background: The relationships between objective cough rates, cough reflex sensitivity, subjective estimates of cough frequency, and cough-related quality of life in patients with COPD are poorly understood.

Subjects: Twenty-six patients with stable COPD who complained of cough (76.9% men; mean ± SD age, 68.7 ± 6.9 years; mean FEV1, 54.2 ± 12.0% of predicted; median smoking history, 42.4 pack-years [range, 13 to 135 pack-years]).

Methods: Subjects performed a cough challenge test, ambulatory daytime and overnight sound recordings, scored the severity of cough (0 to 5 score and visual analog scale) for each recording period, and completed a cough-specific quality of life questionnaire (CQLQ). Coughs were counted manually and quantified in terms of cough seconds per hour (cs/h): the number of seconds within the recording that contain cough.

Results: Overall median time spent coughing was 7.5 cs/h (range, 2.7 to 23.1 cs/h; daytime median, 12.4 cs/h [range, 3.3 to 40.4 cs/h]; overnight, 1.9 cs/h [0.0 to 19.0 cs/h]) [p = <0.01]. Median log concentration of citric acid eliciting five coughs (C5) was − 0.9 mol/L (range, − 1.5 to 0.0 mol/L). Day time but not overnight time spent coughing was significantly correlated with log C5 (log C5 r = − 0.49, p = 0.02, and r = − 0.20, p = 0.37, respectively). Subjective cough scores and visual analog scales were moderately associated with objective time spent coughing: daytime (r = 0.37, p = 0.03, and r = 0.41, p = 0.03) and overnight (r = 0.48, p = <0.01, and r = 0.5, p = 0.01), respectively.

Conclusions: Subjective measures of cough and cough reflex sensitivity are statistically related to time spent coughing in patients with COPD, but with low-to-moderate levels of correlation. These measures have insufficient predictive value to substitute for objective time spent coughing; however, in conjunction with the CQLQ, they may provide a qualitative dimension to the assessment of cough.

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