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Original Research: Signs and Symptoms of Chest Diseases |

The Intensity of Voluntary, Induced, and Spontaneous CoughVoluntary, Reflex, and Spontaneous Cough Intensity

Kai K. Lee, MD; Katie Ward, PhD; Gerrard F. Rafferty, PhD; John Moxham, MD; Surinder S. Birring, MD
Author and Funding Information

From the Division of Asthma, Allergy and Lung Biology, King’s College London, King’s Health Partners, London, England.

CORRESPONDENCE TO: Surinder S. Birring, MD, Division of Asthma, Allergy and Lung Biology, King’s College London, Denmark Hill Campus, Denmark Hill, London, SE5 9RS, England; e-mail: surinder.birring@nhs.net


Part of this article has been presented at the British Thoracic Society Winter Meeting, December 5-7, 2012, London, England.

FUNDING/SUPPORT: Dr Lee was supported by an unrestricted investigator grant from the King’s College Hospital NHS Foundation Trust.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1259-1267. doi:10.1378/chest.15-0138
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BACKGROUND:  The intensity of cough is an important determinant of cough severity. Few studies have quantified cough intensity in patients with chronic cough with objective measures. We investigated the intensity of voluntary, induced, and spontaneous cough in patients with chronic cough and healthy control subjects.

METHODS:  Patients with chronic cough and control subjects underwent physiologic assessment of the intensity of maximum voluntary, capsaicin-induced, and spontaneous cough. Assessments included measurement of gastric pressure (Pga) and esophageal pressure (Pes) during cough, peak cough flow (PCF), expiratory muscle strength (twitch gastric pressure [TwPga]), and cough compression phase duration (CPD). Subjective perception of cough intensity was assessed using a visual analog scale (VAS).

RESULTS:  Pes, Pga, and PCF during maximum voluntary cough were significantly greater in patients with chronic cough compared with control subjects (P = .003-.042). There was no difference in TwPga between patients and control subjects. CPD was increased in female patients compared with control subjects (mean ± SD, 0.50 ± 0.22 s vs 0.28 ± 0.17 s; P = .007). Mean ± SD Pes during spontaneous cough was comparable to induced cough (128 ± 28 cm H2O vs 122 ± 37 cm H2O, P = .686) but less than maximum voluntary cough (170 ± 46 cm H2O, P = .020). Median within-subject correlation coefficients between cough intensity VAS and Pes, Pga, and PCF were r = 0.82 to 0.86.

CONCLUSIONS:  Maximum voluntary cough intensity was increased in patients with chronic cough compared with control subjects. There was no significant difference in expiratory muscle contractility. Further studies should evaluate the compressive phase of cough in more detail. Physiologic measures of cough intensity correlated strongly with subjective perception of intensity in patients with chronic cough and may be relevant objective outcome measures for clinical studies.

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