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Correspondence |

Cough Intensity: Is Respiratory Muscle Activation Important and Does It Relate to Symptoms? FREE TO VIEW

Richard D. Turner, MBChB
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

CORRESPONDENCE TO: Richard D. Turner, MBChB, Department of Respiratory Medicine, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(1):285-286. doi:10.1016/j.chest.2015.09.034
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I read with interest the work of Lee et al in CHEST (2015) concerning the measurement of cough intensity. I wonder, firstly, do the authors have any data relating to respiratory muscle activation, and, secondly, how did cough intensity relate to measures of cough-related quality of life in chronic cough?

Lee et al found that patients with chronic cough had stronger and larger volume coughs than did healthy controls. This difference was apparently not due to respiratory muscle strength, and the authors suggest other mechanisms such as an increased laryngeal compression phase of cough.

Electromyographic measurements have been shown to provide useful information in studies of cough. They have been shown to correlate with cough volume, air flow, sound amplitude, and the stimulus to provoke coughing and can help discriminate between the cough efforts of heathy volunteers and individuals with Parkinson disease. In healthy volunteers, electromyographic values also appear to differ significantly between voluntarily produced coughs and reflex coughs in response to inhalation of a tussive agent. Studying respiratory muscle activation, therefore, could lead to useful insights into mechanisms of coughing in chronic cough.

Overall cough-related quality of life data (Leicester Cough Questionnaire scores) are included in Table 1 (baseline participant characteristics). Although only a small number of spontaneous coughs were analyzed, from nine patients, the authors do not comment on whether there was an association between physiological measures of cough intensity and Leicester Cough Questionnaire scores in chronic cough, or between the subjective perception of cough intensity and overall cough-related quality of life. As stated in the introduction to the article, and as first shown objectively by Loudon and Brown and others in the 1960s, the frequency of coughing is at best only a moderate predictor of symptoms, hence the interest in the intensity of coughing. Further knowledge of the determinants of symptoms in chronic cough would be very welcome for managing this vexing condition.

References

Lee K.K. .Ward K. .Rafferty G.F. .Moxham J. .Birring S.S. . The intensity of voluntary, induced and spontaneous cough. Chest. 2015;148:1259-1267 [PubMed]journal. [CrossRef] [PubMed]
 
Cox I.D. .Wallis P.J. .Apps M.C. .et al An electromyographic method of objectively assessing cough intensity and use of the method to assess effects of codeine on the dose-response curve to citric acid. Br J Clin Pharmacol. 1984;18:377-382 [PubMed]journal. [CrossRef] [PubMed]
 
Fontana G.A. .Pantaleo T. .Lavorini F. .Benvenuti F. .Gangemi S. . Defective motor control of coughing in Parkinson’s disease. Am J Respir Crit Care Med. 1998;158:458-464 [PubMed]journal. [CrossRef] [PubMed]
 
Lasserson D. .Mills K. .Arunachalam R. .Polkey M. .Moxham J. .Kalra L. . Differences in motor activation of voluntary and reflex cough in humans. Thorax. 2006;61:699-705 [PubMed]journal. [CrossRef] [PubMed]
 
Loudon R.G. .Brown L.C. . Cough frequency in patients with respiratory disease. Am Rev Respir Dis. 1967;96:1137-1143 [PubMed]journal. [PubMed]
 

Figures

Tables

References

Lee K.K. .Ward K. .Rafferty G.F. .Moxham J. .Birring S.S. . The intensity of voluntary, induced and spontaneous cough. Chest. 2015;148:1259-1267 [PubMed]journal. [CrossRef] [PubMed]
 
Cox I.D. .Wallis P.J. .Apps M.C. .et al An electromyographic method of objectively assessing cough intensity and use of the method to assess effects of codeine on the dose-response curve to citric acid. Br J Clin Pharmacol. 1984;18:377-382 [PubMed]journal. [CrossRef] [PubMed]
 
Fontana G.A. .Pantaleo T. .Lavorini F. .Benvenuti F. .Gangemi S. . Defective motor control of coughing in Parkinson’s disease. Am J Respir Crit Care Med. 1998;158:458-464 [PubMed]journal. [CrossRef] [PubMed]
 
Lasserson D. .Mills K. .Arunachalam R. .Polkey M. .Moxham J. .Kalra L. . Differences in motor activation of voluntary and reflex cough in humans. Thorax. 2006;61:699-705 [PubMed]journal. [CrossRef] [PubMed]
 
Loudon R.G. .Brown L.C. . Cough frequency in patients with respiratory disease. Am Rev Respir Dis. 1967;96:1137-1143 [PubMed]journal. [PubMed]
 
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