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Original Research: COPD |

Cough and Sputum Production Are Associated With Frequent Exacerbations and Hospitalizations in COPD Subjects

Pierre-Régis Burgel, MD, PhD; Pascale Nesme-Meyer, MD; Pascal Chanez, MD, PhD; Denis Caillaud, MD; Philippe Carré, MD; Thierry Perez, MD; Nicolas Roche, MD, PhD; on behalf of the Initiatives Bronchopneumopathie Chronique Obstructive (BPCO) Scientific Committee
Author and Funding Information

*From the Service de Pneumologie (Dr. Burgel), Hôpital Cochin, Paris Descartes University, Paris, France; Service de Pneumologie (Dr. Nesme-Meyer), Hôpital de la Croix-Rousse, Lyon, France; Département des Maladies Respiratoires (Dr. Chanez), Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France; Centre Hospitalier Universitaire de Clermont-Ferrand (Dr. Caillaud), Hôpital Gabriel Montpied, Service de Pneumologie, Clermont-Ferrand, France; Service de Pneumologie (Dr. Carré), Hôpital Antoine Gayrard, Carcassonne, France; Service d'Explorations Fonctionnelles Respiratoire (Dr. Perez), Hôpital Calmette, Lille, France; and Service de Pneumologie (Dr. Roche), Hôpital de l'Hôtel Dieu, Paris Descartes University, Paris, France.

Correspondence to: Pierre-Régis Burgel, MD, PhD, Service de Pneumologie, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, 27 rue du Faubourg St Jacques, 75679 Paris Cedex 14, France; e-mail: pierre-regis.burgel@cch.aphp.fr

†A list of members of the Initiatives Bronchopneumopathie Chronique Obstructive (BPCO) Scientific Committee is located in the Appendix.


This work was funded by unrestricted grants from Boehringer Ingelheim France and Pfizer.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2009;135(4):975-982. doi:10.1378/chest.08-2062
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Background:  Epidemiologic studies indicate that chronic cough and sputum production are associated with increased mortality and disease progression in COPD subjects. Our objective was to identify features associated with chronic cough and sputum production in COPD subjects.

Methods:  Cross-sectional analysis of data were obtained in a multicenter (17 university hospitals in France) cohort of COPD patients. The cohort comprised 433 COPD subjects (65 ± 11 years; FEV1, 50 ± 20% predicted). Subjects with (n = 321) and without (n = 112) chronic cough and sputum production were compared.

Results:  No significant difference was observed between groups for age, FEV1, body mass index, and comorbidities. Subjects with chronic cough and sputum production had increased total mean numbers of exacerbations per patient per year (2.20 ± 2.20 vs 0.97 ± 1.19, respectively; p < 0.0001), moderate exacerbations (1.80 ± 2.07 vs 0.66 ± 0.85, respectively; p < 0.0001), and severe exacerbations requiring hospitalizations (0.43 ± 0.95 vs 0.22 ± 0.56, respectively; p < 0.02). The total number of exacerbations per patient per year was the only variable independently associated with chronic cough and sputum production. Frequent exacerbations (two or more per patient per year) occurred in 55% vs 22% of subjects, respectively, with and without chronic cough and sputum production (p < 0.0001). Chronic cough and sputum production and decreased FEV1 were independently associated with an increased risk of frequent exacerbations and frequent hospitalizations.

Conclusions:  Chronic cough and sputum production are associated with frequent COPD exacerbations, including severe exacerbations requiring hospitalizations.

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