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We read with interest the paper by Niimi et al1 published in February’s edition of Thorax in which the authors identified a small number of patients with unexplained recurrent pneumonias and reduced cough reflex sensitivity to capsaicin compared with an age and sex matched control group. It does seem intuitively reasonable that the risk of aspiration pneumonia might be greater in those with diminished cough responses, and this has already been demonstrated in post-stroke patients.2
Our concerns with this study are twofold. The first is the finding that unexplained recurrent pneumonia is uncommon (seven cases over a 5 year period) whereas insensitivity to tussive stimuli is relatively common in normal healthy volunteers. Indeed, it has been a sufficiently regular occurrence that the majority of cough challenges developed have had to incorporate an in-built method of assigning a theoretical cough threshold to non-coughers. This is usually taken as either the greatest concentration inhaled or the next incremental concentration which would have been inhaled if the test had continued. The proportion of subjects who do not cough will …
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