Article Text

Sex differences and predictors of objective cough frequency in chronic cough
  1. A Kelsall1,2,
  2. S Decalmer1,
  3. K McGuinness1,2,
  4. A Woodcock1,2,
  5. J A Smith1
  1. 1
    Respiratory Research Group, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  2. 2
    North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
  1. Dr J A Smith, Education and Research Centre, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK; jacky.smith{at}


Background: Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. A study was conducted to determine the predictors of objective cough frequency in patients presenting to a tertiary referral clinic with chronic cough.

Methods: 100 subjects (65 women) of mean (SD) age 55.8 (11.0) years and median cough duration 4 years (IQR 2.0–10.0) with unexplained chronic cough completed flow-volume loops (mean (SD) forced expiratory volume in 1 s 103 (15.2)% predicted; forced expiratory flow (FEF50) 68.8 (24.1)% predicted), methacholine challenge (42% positive), citric acid cough reflex sensitivity (C5; 0.12 M (IQR 0.06–0.50)) and the Leicester Cough Questionnaire. 24-h ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour.

Results: Women coughed significantly more than men (geometric mean 16.6 coughs/h (95% CI 13.1 to 21.0) vs 9.4 coughs/h (95% CI 6.4 to 13.9), p = 0.01)). The cough reflex was also more sensitive in women than in men (median logC5 −0.9 M vs −0.6 M, p = 0.002), but cough-related quality of life was similar in women and men (12.0 (3.6) and 12.2 (3.2), respectively, p = 0.76). Linear regression analysis showed that 38.6% of the variation in cough rate was predicted by sex (p = 0.01), logC5 (p<0.001) and age (p = 0.002) but not lung function or bronchial hyper-reactivity.

Conclusions: Ambulatory objective cough monitoring provides novel insights into factors modulating chronic cough. These findings suggest that effects of sex and age must be taken into account in the study of cough and when designing clinical trials testing novel antitussive agents.

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  • See Editorial, p 372

  • Additional figures are published online only at

  • Funding: This study was funded by a grant from the Moulton Charitable Trust and JAS is funded by a Fellowship from Manchester University. Neither funding body had any involvement in the study design, collecting of the data, analysis or interpretation of the data or in writing of this report.

  • Competing interests: KM, AW and JAS are inventors on a patent describing novel methods for cough detection and monitoring filed by the University Hospital of South Manchester. KM, AW and JAS have an industrial collaboration and the University Hospital of South Manchester has a license agreement with Vitalograph Ltd to develop a commercial cough monitoring system (Vitalojak).

  • Ethics approval: Ethics approval was granted by South Manchester local research ethics committee and written informed consent was completed by all subjects.

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